The Clinical Problem Solvers Episode 413: Rafael Medina Hepatology Episode with Dr. Tapper – Driver or Bystander
Aug 15, 2025
Elliot Tapper is an Associate Professor in Gastroenterology and Hepatology at the University of Michigan, while Hirsh Elhence is an Internal Medicine resident at the University of Colorado with a keen interest in hepatology. They explore whether the liver is a driver of health issues or merely a bystander. Key topics include navigating liver transplant evaluations, distinguishing between acute liver injury and acute liver failure, and unraveling complex liver cases. Their engaging dialogue emphasizes patient-centered care and the importance of detailed medical assessment.
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Prioritize Infection And Drinking History
- When triaging transfers for possible transplant, prioritize whether the patient has been actively drinking and screen for infection, renal failure, and GI bleeding.
- Stabilize hemodynamics and investigate infection sources early because infection, renal failure, and bleeding are the common fatal outcomes in alcohol-associated hepatitis.
Differentiate ALF From Alcohol Hepatitis
- Distinguish acute liver failure from alcohol-associated hepatitis by enzyme pattern and encephalopathy rather than bilirubin alone.
- Alcohol-associated hepatitis often has modest transaminase elevations (AST usually <~300) and can present with high bilirubin and INR without classic massive enzyme rises.
Very Low Platelets Suggest Systemic Disease
- Extremely low platelets (e.g., 5) and marked coagulopathy should prompt consideration of nonhepatic processes like DIC or hematologic malignancy.
- Factor VIII elevation and schistocytes argue for an evolving systemic coagulopathy rather than isolated liver-only dysfunction.
