Pattern Recognition
AST and ALT in the 1000s but Alk Phos is within normal limits
What is hepatocellular liver injury pattern?
Most common cause of cholestatic liver disease in middle-aged women with anti-mitochondrial antibody positivity
What is primary biliary cholangitis?
general name for acute or chronic liver injury caused by medications (both prescribed and OTC) and herbal supplements
What is a drug induced liver injury (DILI)?
Initial imaging study for someone with suspected biliary obstruction
What is a RUQ ultrasound?
the most common cause of acute liver injury in the United States
What is acetaminophen toxicity?
Alk Phos is disproportionately elevated compared to AST/ALT.
What is a cholestatic injury pattern?
Labs show AST 65, ALT 80, normal bilirubin, normal Alk Phos. Ultrasound shows steatosis.
What is metabolic dysfunction associated steatotic liver disease (MASLD)?
Antidote for acetaminophen toxicity
What is N-acetylcysteine?
Intervention following an MRCP that shows choledocholithiasis
What is an ERCP (with sphincterotomy and stone extraction)?
Neonate presenting with jaundice and pale stools
What is biliary atresia?
Most likely source of isolated elevated Alk Phos with normal GGT
What is bone (non-hepatic origin)?
Labs show hyperbilirubinemia with elevated AST and ALT (AST >> ALT). MCV 110
What is alcohol-associated hepatitis?
Most common antibiotic causing delayed liver injury (weeks after exposure)
What is amoxicillin-clavulanate (Augmentin)?
Imaging modality used to stage fibrosis noninvasively in chronic liver disease
What is transient elastography (FibroScan) or MRE?
16 yo with tremors, dysarthria, and elevated LFTs with a low ceruloplasmin
What is Wilson's Disease?
This calculation helps distinguish hepatocellular vs cholestatic injury using ALT and Alk Phos
What is the R factor?
Hepatocellular injury with positive ANA and anti–smooth muscle antibodies
What is autoimmune hepatitis?
If this score is above 32, you should consider starting corticosteroids
What is the Maddrey's Discriminate Function?
Next step: Incidental steatosis on imaging with mild ALT elevation
What is a metabolic workup (lipids, A1c, etc.) and lifestyle modification counseling?
Infant with cholestasis, high GGT, and cardiac anomalies
What is Alagille syndrome?
Diagnosis for a pt admitted to the Highland ICU. AST and ALT in the 1000s with elevated LDH (normalizes rapidly)
What is ischemic hepatitis?
Associated with ulcerative colitis and presents with stricturing of bile ducts
What is primary sclerosing cholangitis?
What is isoniazid?
Next step: Hepatocellular pattern with negative viral and autoimmune workup
What is a liver biopsy?
Microvesicular steatosis and encephalopathy in a child after viral illness treated with OTC antipyretics
What is Reye syndrome?