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Approach to Gout Diagnosis: r/o septic arthritis! Needle-shaped, negative birefringent crystals Treatment: • Weight loss, diet, d/c culprit
Lowering Therapy (ULT ... gout #diagnosis #management ... #treatment #ULT
Gout - Management Acute Gout Flare 1) colchicine, NSAIDs, glucocorticoids 2) Anakinra (IL-1 inhibitor) When to Start Urate
Gout - Management ... Lowering Therapy (ULT ... MithuRheum #Gout #Management
Liver Function Test (LFTs) Elevation AST - Cardiac and skeletal muscle, kidney, brain ALT - More specific for
kidney, brain ALT ... ≥ 3x ULN Cholestatic ... R Value = (ALT ... / ULN ALT) / (ALP ... / ULN ALP)
Abnormal Liver Function Tests - Differential Diagnosis Algorithm for Transaminitis Hepatocellular Pattern (ALT or AST > ALP):
: • Severe - ALT ... >15X ULN ... • Moderate - ALT ... < 5x ULN ... Pattern (ALP > ALT
Liver Enzymes (LFTs) - Causes of Hepatocellular and Cholestatic Liver Injury Hepatocellular Liver Injury • AST/ALT elevation
Injury • AST/ALT ... > Alk phos • ALT ... • R value = (ALT ... + ULN ALT) / (alkaline ... phosphatase + ULN
Elevated Liver Enzymes - Differential Diagnosis Algorithm Severe ALT > 15x ULN • Viral • Drugs/Toxins •
Algorithm Severe ALT ... > 15x ULN • Viral ... HELLP Moderate ALT ... 5-15x ULN • Viral ... • Others Mild ALT
Acute Fatty Liver of Pregnancy (AFLP) Pathophysiology: • Defect in fetal free fatty acid metabolism products →
Findings: • ↑AST/ALT ... (5-10x ULN), ↑Tbili ... Cr, ↓Glucose, ↓PLT ... Intrahepatic Cholestasis Management ... obgyn #diagnosis #management
Autoimmune Hepatitis Clinical Presentation - Highly variable clinical presentation, from subclinical disease to acute liver failure. -
Hepatitis (eg Viral) Management ... + AST > 10x ULN ... - ALT + AST > ... 5x ULN AND IgG ... AIH #Diagnosis #Management
Liver Chemistries - Interpretation of LFTs R-value: Serum (ALT/ULN ALT) / (Alk phos/ULN ALP) • R >
R-value: Serum (ALT ... /ULN ALT) / (Alk ... phos/ULN ALP) ... to liver than ALT ... • ALT: Specific
Hepatitis B - Treatment Indications Treatment not indicated: • Immune tolerant state - HBe-Ag detectable, high HBV
IU/mL), normal ALT ... IU/mL), normal ALT ... IU/mL), normal ALT ... 2000 IU/mL and ALT ... #Indications #management
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