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)
- 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)
Posted 09/19/16 10:16:10 AM by Anna Krigel
- 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'
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