UW revision alcohol hepatitis+abnormal liver test aproach Hx

Question 1

AH. CP? general

Answer 1

fever, anorexia, jaudice

Question 2

AH. CP? abdomen

Answer 2

RUQ and/or epigastric pain (hepatic pain)

Abdominal distension due to ascites (if cirrhosis)

Possible hepatic encephalopathy (gal labiau if cirrhosis)

Question 3

AH. CP? muscles

Answer 3

Proximal muscle weakness from muscle wasting if malnourished

Question 4

AH. Labs. AST ALT

Answer 4

AST>=2 : ALT

Both elevated, but usually less than <300 and almost always <500.

can be mild transaminitis in usmle. Eg both <100, just AST a bit higher than ALT

Both normal <50

Question 5

AH. Lab other elevated?

Answer 5

GGT
Ferritin (acute phase reactant)
INR, bilirubin

Question 6

AH. Lab blood?

Answer 6

leukocytes (neutrophiles)

Question 7

AH. albumin?

Answer 7

decr. if malnourished

Question 8

AH. imaging?

Answer 8

Abdominal imaging may show fatty liver
Biopsy - mallory hyaline

Question 9

Abnormal liver lab. Hx. Alco?

Answer 9

detailed alcohol intake assessment (frequency, quantity)

Question 10

Abnormal liver lab. Hx. hepatitis?

Answer 10

Hepatitis risk factors assesments - eg sexual history

Question 11

Abnormal liver lab. Hx. medications?

Answer 11

medications review (eg acetaminophen, supplement use)

Question 12

Abnormal liver lab. Hx. family?

Answer 12

Family Hx eg autoimmune disease

Question 13

Abnormal liver lab. Assess CP? 4

Answer 13

Stigmata of cirrhosis (palmar erythema, spider angiomas)

Signs of malignancy (lymph node enlargement)

Volume overload (elevated JVP)

Visceral obesity (truncal obesity)

Question 14

Abnormal liver lab. Diagnostic test? in general

Answer 14

Selective lab tests based on risk factors.

Question 15

Abnormal liver lab. Diagnostic test. HEPATOCELLULAR PATTERN?

Answer 15

Viral serologies, antinuclear antibody, iron studies

Question 16

Abnormal liver lab. Diagnostic test. CHOLESTATIC PATTERN?

Answer 16

GGT, pancreatic enzymes, liver UG