The Curbsiders Internal Medicine Podcast

#302 LFTs Triple Distilled

7 snips
Oct 27, 2021
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ADVICE

Use R Score For Pattern Classification

  • Use the R score to classify liver injury as hepatocellular, cholestatic, or mixed by comparing ALT to ALP ratios.
  • Calculate R = (ALT/ALT ULN) ÷ (ALP/ALP ULN) and interpret >5 hepatocellular, 2–5 mixed, <2 cholestatic.
ADVICE

Initial Tests For Acute Hepatocellular Injury

  • For acute hepatocellular injury, check hepatitis A, B, C serologies and acetaminophen level promptly and review medications thoroughly.
  • Also consider ischemia, autoimmune hepatitis, and get bilirubin to gauge severity; higher bilirubin implies worse injury.
ADVICE

How To Evaluate Suspected Autoimmune Hepatitis

  • If you suspect autoimmune hepatitis, order ANA, IgG, and anti–smooth muscle antibody as part of the workup.
  • Refer to hepatology before starting treatment; tissue biopsy is often required to confirm and guide therapy.
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