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Elevated Liver Function Tests, Abnormal Lfts, Asymptomatic Patients, Hereditary Hemochromatosis, Hepatic Steatosis, Viral Hepatitis, Muscular Disorders, Celiac Disease are some points in Introduction to General Medicine lecture. This lecture is one of 61 lectures you can find here for this course.
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Senior talk 2009
MAISSAA JANBAIN, MD
Abnormal LFTs are frequently detected in asymptomatic patients (1-4%).
They do not always reflect liver diseases.
They may be a marker of worse health outcomes.
Medications (NSAIDs, Anitbiotics, statins,
antiepileptics and herbal preparations)
Alcohol (AST/ALT >2:1, twofold elevation
of GGT)
Hereditary hemochromatosis (Caucasian, iron,
TIBC, ferritin +/- liver biospy)
Viral hepatitis: HBV ( HBsAg, anti HBsAg, anti HBc) and HCV ( ELISA, RIBA, PCR )
Hepatic steatosis and NASH ( AST/ALT<1, ultrasound, CT or MRI)
Wilson ‘s disease (age 5-25, serum ceruloplasmin, 24hr urine for copper, liver biopsy)
Autoimmune hepatitis ( SPEP, ANA , SMA, LKMA, liver biopsy)
Alpha 1 antitrypsin (associated emphysema, protein electrophoresis)
If no cause was identified and ALT, AST elevation is less than tow fold, no more investigations.
Biopsy is done otherwise eventhough it is less likely to provide diagnosis or lead to changes in management.
Alk phos is derived from liver, bones, intestins and placenta.
Levels vary with age, more elevated in children.
To determine the source we check GGT or 5’ nucleotidase.
Initial evaluation includes U/S and AMA followed by ERCP v/s liver biopsy.
Very sensisitive for hepatobiliary disease but not specific.
Can reflect pancreatic disease, MI, renal failure, diabetes, COPD, alcoholism.
u/s shows biliary dilatation, and usually is followed by ERCP v/s CT scan.
Choleodocholithiasis is the most common.
Other causes include: malignancies, PSC, chronic pancreatitis and HIV cholangiopathy due to CMV or cryptosporidium (usually with no jaundice)
Viral hepatitis (A, B, C, EBV, CMV)
Alcoholic hepatitis
PBC
Drugs (anabolic and OCPs, usually reversible)
Vanishing bile duct syndrome, adult bile ductopenia (chronic rejection, sarcoidosis)
Benign recurrent cholestasis (AR)
Pregnancy
TPN, sepsis, post-op, Stauffer’s syndrome
Usually acute self limited rarely fulminant especially if associated with chronic hep C.
Manifestations vary with age, more silent in children.
Incubation period of 30 days followed by abrupt prodromal symptoms then jaundice.
Extrahepatic manifestations : vasculitis, optic neuritis, thrombocytopenia, aplastic anemia, transverse myelitis.
IgM anti HAV is the gold standard for diagnosis.
Start at the onset of symptoms and remain positive 4-6 months.
Infected individuals are contagious during incubation and for a week after jaundice appears.
Handwashing is very important !!! As HAV survives for up to 4 hrs on fingertips.