-
Palmar erythema -> palms not just red and mottled but also pillowy and tufty
Posted 09/19/16 10:02:03 AM by Anna Krigel
-
Acute Liver Injury
- Elevated transaminases (if higher than 1000s think drug-induced, acute viral hepatitis, ischemic injury, possibly autoimmune hepatitis)
- Hyperbilirubinemia
- AKI
- Mild hypoglycemia
- Coagulopathy (INR>1.5)
Acute Liver Failure
- All elements of acute liver injury
- Altered mental status, asterixis, encephalopathy
Posted 09/19/16 10:10:23 AM by Anna Krigel
-
Clues in the hepatic function panel
- Globulin gap in a young woman with acute liver injury or failure points to autoimmune hepatitis
- Low alkaline phosphatase in a patient with acute liver injury or failure points to Wilson's disease (can present at almost any age)
Posted 09/19/16 10:11:52 AM by Anna Krigel
-
Acute liver injury work up
- acetaminophen level, Utox
- Viral serologies (HAV, HBV, HCV, HSV)
- ANA, Anti-smooth muscle Ab, Anti-mitochondrial Ab, Anti-LKM-1, immunoglobulin levels
- Iron studies
- Ceruloplasmin, 24 hour urine copper (because ceruloplasmin is an acute phase reactant and will be high in acute settings)
- HIV
Posted 09/19/16 10:16:10 AM by Anna Krigel
-
Autoimmune hepatitis
- Type 1 (80%) -> more classic presentation, seen in young women, see positive ANA, anti-smooth muscle Ab, elevated IgG levels, and plasma cell infiltrate on histology
- Type 2 (20%) -> seen in pediatric patients, have positive anti-LKM-1 Ab
- Induction therapy is with high dose glucocorticoids with or without azathioprine
- Up to 80% of patients achieve remission after induction therapy, then glucocorticoids can be tapered, though 50-90% of patients will relapse within 12 months of drug tapering
- Can be maintained on low dose prednisone or azathioprine
Posted 09/19/16 10:18:49 AM by Anna Krigel
-
For further reading...
Posted 09/19/16 10:24:20 AM by Anna Krigel
Created by Christopher Kelly
Know a hypochondriac? Get them the best-selling book 'AM I DYING?!: A Complete Guide to Your Symptoms, and What to Do Next'
The information on the website does not constitute official guidelines except where explicitly stated.
It is not meant to replace the advice of a health professional.