Elevated aminotransferases and alkaline phosphatase levels

Question 1

cholestasis is

Answer 1

high alkaline phosphatase levels with direct hyperbilirubinemia

Question 2

causes of cholestasis

Answer 2

choledocholithiasis,

primary sclerosing cholangitis,

malignant biliary obstruction

intrahepatic (primary biliary cirrhosis, drug toxicity, pregnancy, post operative, infectious hepatitis).

Question 3

initial evaluation of cholestasis

Answer 3

U/S abdomen for biliary obstruction

Question 4

if there’s no biliary obstruction in context of cholestasis on U/S the nconsider

Answer 4

intrahepatic cholestasis need to get anti mitochrondrial antibodies and b

Question 5

which drugs can cause drug induced cholestasis?

Answer 5

antibiotics

Question 6

DILI or drug induced liver injury is

Answer 6

development of liver injury from initiating a known offending medicaiton and absence of underlying liver disease and improvement in liver function after drug cessation

Question 7

how to treat drug induced cholestasis and drug induced liver injury?

Answer 7

remove offending agent.

Question 8

evaluation of elevated alkaline phosphatase algorithm

Answer 8

Question 9

elevation in LFTS

Answer 9

Question 10

Hepatic encephlopathy

hemolytic anemia

LOW alkaline phosphatase level

unconjugated bilirubinemia

Answer 10

Wilson’s dx

causes low alkaline phosphatase levels with hemolytic anemia.

Question 11

Approach to abnormal transaminases

Answer 11

while NAFLD is a possibility it’s a diagnosis of excusion.

Need to rule out ETOH use, medications, and hepatitis infection and hemochromatosis.