SYSTEMATIC APPROACH TO LIVER FUNCTION TEST
BY Dr. Navas Shareef. P.P (MBBS)
THIS PRESENTATION IS MADE IN A SIMPLIFIED FORM SO THAT EVERYONE COULD UNDERSTAND ABOUT A LIVER FUNCTION TEST EASILY
SYSTEMATIC APPROACH TO LIVER FUNCTION TEST
BY Dr. Navas Shareef. P.P (MBBS)
THIS PRESENTATION IS MADE IN A SIMPLIFIED FORM SO THAT EVERYONE COULD UNDERSTAND ABOUT A LIVER FUNCTION TEST EASILY
Beyond LFT - A Radiologist’s Guide to the Liver Blood TestsAbhineet Dey
Abnormal liver blood test results are often the first indicator of hepatobiliary disease and a common indication for abdominal imaging with US, CT, or MRI.
Most of the disease entities can be categorized into hepatocellular or cholestatic patterns, with characteristic traits on liver blood tests. Each pattern has a specific differential, which can help narrow the differential diagnosis when combined with the clinical history and imaging findings.
Overall, integrating liver blood test patterns with imaging findings can help the radiologist accurately diagnose hepatobiliary disease, especially in cases where imaging findings may not allow differentiation between different entities.
the following document contains various diagnostic test for screening liver function. and interpretation of results, which may confirm the presence of a disease or disorder
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Beyond LFT - A Radiologist’s Guide to the Liver Blood TestsAbhineet Dey
Abnormal liver blood test results are often the first indicator of hepatobiliary disease and a common indication for abdominal imaging with US, CT, or MRI.
Most of the disease entities can be categorized into hepatocellular or cholestatic patterns, with characteristic traits on liver blood tests. Each pattern has a specific differential, which can help narrow the differential diagnosis when combined with the clinical history and imaging findings.
Overall, integrating liver blood test patterns with imaging findings can help the radiologist accurately diagnose hepatobiliary disease, especially in cases where imaging findings may not allow differentiation between different entities.
the following document contains various diagnostic test for screening liver function. and interpretation of results, which may confirm the presence of a disease or disorder
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
Follow us on: Pinterest
Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
The Gram stain is a fundamental technique in microbiology used to classify bacteria based on their cell wall structure. It provides a quick and simple method to distinguish between Gram-positive and Gram-negative bacteria, which have different susceptibilities to antibiotics
Best Ayurvedic medicine for Gas and IndigestionSwastikAyurveda
Here is the updated list of Top Best Ayurvedic medicine for Gas and Indigestion and those are Gas-O-Go Syp for Dyspepsia | Lavizyme Syrup for Acidity | Yumzyme Hepatoprotective Capsules etc
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
2. Liver Function Test
Albumin
Bilirubin:
Total Bilirubin
Direct Bilirubin (conjugated bilirubin)
Serum aminotransferases
Aspartate aminotransferase (AST)
Alanine aminotransferase (ALT)
Alkaline Phosphatase
Prothrombin time
3. Albumin
Synthesized in the liver
Production is controlled by multiple factors
including nutritional status, serum oncotic
pressure, cytokines, and hormones
A serum albumin may be reflection of the
synthetic function of the liver.
5. Bilirubin
Used to determine liver’s ability to clear
endogenous/exogenous substances from the
circulation
Indirect (unconjugated) bilirubin
Elevated with hemolysis, hepatic disease
Direct (conjugated) bilirubin
Elevated with biliary obstruction and hepatocellular
disease.
Jaundice usually develops with a bilirubin ≥ 3
mg/dL
7. Aminotransferases
Hepatic enzymes that are usually
intracellular, but are released from
hepatocytes with hepatocellular injury.
Includes aspartate aminotransferase (AST)
and alanine aminotransferase (ALT)
AST/ALT ratio
Normal is 0.8
In alcoholic hepatitis, is usually > 2
8. Alkaline Phosphatase
A group of enzymes that catalyze the hydrolysis of a large
number of organic phosphate esters.
In liver, believed to play an active role in down-regulating the
secretory activities of the intrahepatic biliary epithelium
Found in:
Liver
Bone
intestine
First trimester placenta
Kidney
Gamma-glutamyl transpeptidase (GGT):
Liver origin: Elevated GGT
Bone origin: Normal GGT
9. Prothrombin Time (PT)
Liver is in charge of the synthesis of many clotting
factors :
Factor I (fibrinogen)
Factor II (prothrombin)
Factor V
Factor VII
Factor IX
Factor X
Factors XII and XIII
Elevated PT may be reflection of decreased
synthetic activity of liver.
10.
11. Assessing the patient with abnormal
Liver Function Tests
Most of the time, the cause of elevated LFTs can
be illicited without invasive testing (biopsy)
If no cause of abnormality is found, most
frequently the cause is alcohol liver disease,
steatosis, or steatohepatitis
Certain patterns exist with LFTs
Hepatocellular Injury: Very high AST, ALT with
mild/moderately elevated alkaline phosphatase.
Cholestatis: mild/moderately elevated AST/ALT with very
high alkaline phosphatase
Bilirubin can be elevated with both combinations.
12. Hepatocellular Injury
Medications:
History: Need to assess temporal relationship with drug, see if
patient improves once medication removed
NSAIDs, antibiotics, statins, anti-tuberculosis medications,
anti-epileptic drugs, acetaminophen
Frequently cause isolated elevated aminotransferases
Acetaminophen overdose
Toxicity is likely to occur with single ingestions greater than 250
mg/kg or those greater than 12 g over a 24-hour period
AST/ALT elevations is first sign of liver damage (usually 24-hours
after ingestion)
Alcohol Use:
Frequently have AST:ALT ratio ≥ 2:1
History: Need accurate assessment of alcohol intake, including
CAGE questions.
13. Hepatocellular Injury
Hepatitis A:
Acute infection
History: travel, recent outbreak, MSM; nausea, vomiting, jaundice
Labs: Hepatitis A IgM, frequent elevated bilirubin
Hepatitis B:
Can be acute or chronic
History: See if patient from Asia, Subsaharan Africa; Sexual history, Drug use
Labs: Hepatitis B surface antigen, surface antibody, core antibody
Hepatitis C:
History: IV drug abuse, blood transfusion prior to 1992, Sexual history, Tattoos
Labs: Hepatitis C antibody (Hepatitis C viral load if HIV positive or
immunocompromised)
HIV:
Often causes isolated elevated aminotransferases
History: Sexual History, IV drug use
Labs: HIV Antibody test (ELISA with reflex Western Blot)
14. Hepatocellular Injury
Hereditary Hemochromatosis
History: Family history of liver disease? Diabetes? Heart
Failure? Bronze skin?
Labs:
Serum iron, TIBC
Calculate iron saturation = serum iron/TIBC
If iron saturation > 45%, check ferritin
Ferritin
If > 400 ng/mL in men, or > 300 ng/mL in women, then need to check
liver biopsy or genetic testing
Liver biopsy
Homozygous hereditary hemochromatosis if iron index > 1.9
If under age 40, and positive genetic testing, no biopsy needed.
Genetic Testing
15. Hepatocellular Injury
Hepatic steatosis/Non-alcoholic
steatohepatitis (NASH)
Increase in AST/ALT are usually less than 4-fold.
Ratio of AST/ALT is usually < 1
History: Female, obesity, diabetes
Labs:
Labs to rule out other causes of hepatitis
Abdominal Ultrasound: look for fatty infiltration of
liver
16. Hepatocellular Injury
Autoimmune Hepatitis
History: Young to middle-aged female
Labs:
Serum protein electrophoresis (SPEP) – if
polyclonal increase in gamma globulin
Anti-nucleur antibody: Positive
Anti-smooth-muscle antibody (SMA)
Liver biopsy: should be performed if the above
are negative, but autoimmune hepatitis still
suspected.
17. Alpha-1-antitrypsin deficiency
History: Family history, emphysema,
young age
Labs:
Alpha-1-antitrypsin level/phenotype
Treatment:
Intravenous alpha-1 antiprotease helps
with lung disease, but liver transplant is
ultimately only treatment for liver
disease.
Hepatocellular Injury
18. Hepatocellular Injury
Wilson’s Disease
A genetic disorder of biliary copper excretion
History: Age (usually age 5 – 25, but up to age 40), family
history of liver disease; neuropsychiatric disease
Evaluation:
Serum ceruloplasmin: Low
Opthalmologist: Exam for Kayser-Fleisher rings
24-hour urine copper
Liver biopsy: Evaluate liver copper levels
Treatment:
Copper chelating agents
Zinc
In some cases, ultimately liver transplant
20. Hepatocellular Injury
Shock Liver (ischemic hepatitis)
Etiology: Shock, severe hypotension
Severely elevated AST/ALT (50 times normal)
Treatment: Re-establish good blood
pressure/perfusion.
Prognosis: Usually patients recover, but can
progress to fulminant liver failure requiring
transplant.
21. Hepatocellular Injury
Non-Hepatic Causes
Usually only mild increase in AST/ALT
Muscle disorders
Hypothyroidism/Hyperthyroidism
Celiac Disease
Adrenal Insufficiency
Anorexia nervosa
22. Hepatocellular Injury
What if work-up is negative and AST/ALT
remain elevated?
Observe:
Patients with two-fold or less increase in AST/ALT
and no hyperbilirubinemia
Liver Biopsy
Patients with > two-fold increase in AST/ALT, or
abnormalities of other liver function tests.
23. Cholestatic Pattern
Predominantly elevated alkaline phosphatase
Need to check GGT to see if bone or liver in origin
Blood types O and B: can have elevated serum
alkaline phosphatase after eating a fatty meal due
to an influx of intestinal alkaline phosphatase
Need to determine if the cholestasis is
intrahepatic or extrahepatic in origin.
25. Cholestatic Pattern - Intrahepatic
Primary Biliary Cirrhosis
Autoimmune disease
Predominately in women, usually ages 35-65
May have history of other autoimmune disease
Symptoms: Prurutis, fatigue, hyperpigmentation,
musculoskeletal complaints
Labs:
RUQ Ultrasound
Anti-mitochondrial antibody
Liver biopsy to verify diagnosis
26. Cholestatic Pattern – Both Intrahepatic
and Extrahepatic
Primary Sclerosing Cholangitis
chronic progressive disorder of unknown etiology that is characterized by
inflammation, fibrosis, and stricturing of medium size and large ducts in the
intrahepatic and extrahepatic biliary tree
~ 90% have inflammatory bowel disease, especially ulcerative colitis
Symptoms: Pruritus, fatigue, RUQ pain
Diagnosis:
Ultrasound
Cholangiogram: multifocal stricturing and dilation of intrahepatic and/or
extrahepatic bile ducts
Prognosis:
Poor; average life expectancy after diagnosis is ~12 years
10-15% risk of developing cholangiocarcinoma
Liver transplant is ultimate only treatment
29. Cholestatic Pattern - Extrahepatic
Chronic Pancreatitis
History: Recurrent pancreatitis
Symptoms: Abdominal pain, frequently referred to back
HIV Cholangiopathy
Usually seen in AIDS patients with CD4 count well below
100/mm3
Usually caused by: Cryptosporidium. Microsporidium, CMV
Symptoms: RUQ pain, Diarrhea, Occassional fever,
Occassional jaundice
Diagnosis:
ERCP
Cholangiography – shows multifocal strictures of extrahepatic
biliary tree
30. Isolated Hyperbilirubinemia
Unconjugated (indirect) hyperbilirubinemia
Overproduction of bilirubin
Hemolysis
Dubin-Johnson Syndrome and Rotor Syndrome
Decrease in uptake, conjugation, or excretion of
bilirubin
Increased unconjugated (indirect) bilirubin
Liver Disease
31. Isolated Unconjugated
Hyperbilirubinemia
Drugs
Probenecid, Rifampicin
Gilbert’s Disease
Autosomal recessive disorder
3 to 7 % of population
Most common in white males
Jaundice, increased unconjugated bilirubin (always < 6)
Occurs when patient under stress/infection
Crigler-Najjar type II
Caused by gene mutation
Reduced activity of Bilirubin UDP glucuronosyl
34. SUMMARY
Isolated elevated indirect (unconjugated)
bilirubin
Hemolysis
Drugs
Gilbert’s Disease
Crigler-Najjar type II
35. Scenario # 1
A 43-year old woman who has consumed a pint of
80-proof whiskey daily for 18 years presents with
right upper quadrant pain. The pain began
approximately a week ago and has been
transiently relieved by her taking two extra-
strength acetaminophen tablets every 4 hours for
the past 4 days. She has had some nausea and
vomiting but no fever. There is no history of
jaundice or cholelithiasis. The patient used
intravenous drugs and shared needles during her
late teen years.
36. Scenario # 1
Physical Exam
Enlarged tender liver that percusses to 17 cm in
the right midclavicular line and a tattoo on the
right buttock
Labs:
Bilirubin: 2 mg/dL AST: 3800
Alk. Phos: 198
PT: normal
37. Scenario #1
The most likely diagnosis is:
(A) Alcoholic hepatitis
(B) Acute cholecystitis
(C) Acetaminophen hepatotoxicity
(D) Acute viral hepatitis B
(E) Acute viral hepatitis C
38. Scenario # 2
A 54-year old asymptomatic man volunteers to
donate blood and is found to have elevated
aminotransferase levels. He has no known
medical problems and no history of hepatitis. He
drinks no alcohol, takes no medications, and has
not seen a physician in more than 10 years. He is
active, works as a truck driver, and has noted no
change in his physical condition. He has no
family history of liver disease.
39. Scenario # 2
Physical Exam:
Obesity – Ht: 5’ 10”, 115 kg
Labs:
AST: 45 ALT: 85 Alk. Phos: 90
Hepatitis serologies (A, B, C): negative
ESR: normal ANA: negative
Smooth muscle antibody: negatie
Total chol: 260 LDL; 225 Triglycerides: 830
Liver biopsy:
Large-droplet steatosis without significant inflammatory reaction
and no fibrosis. Ultrasonography shows a mildly enlarged fatty
liver.
40. Scenario # 2
The appropriate management of this patient
would be:
(A) Interferon therapy for presumed chronic non-B, non-C
hepatitis
(B) Alcohol rehabilitation and counseling
(C) Weight loss and therapy for hyperlipidemia
(D) Endoscopic retrograde cholangiopancreatography
(ERCP) to evaluate the biliary tree
(E) Corticosteroid therapy
41. Scenario # 3
A 43-year old woman complains of itching that
keeps her awake at night. Physical examination
is normal except for the liver, which is felt 7 cm
below the right costal margin.
CBC is normal
Creatinine: 0.8 mg/dL, Bilirubin: 0.6 mg/dL
ALT: 78 U/L, Albumin: 4.2 g/dL
Alkaline Phosphatase: 450 U/L
Cholangiogram: normal
42. Scenario # 3
Which test would be most accurate in
diagnosing her underlying disorder?
(A) Serum protein electrophoresis
(B) Anti-Smooth Muscle Antibody
(C) Antimitochondrial antibody
(D) Technetium-99m liver-spleen scan
(E) Endoscopic retrograde
cholangiopancreatography (ERCP)