Abnormal Liver Function tests

Age: ‍ years old

Gender: ‍malefemale



HISTORY:

Presents for ‍abnormal liver function tests



Lab results:

ALT ‍, AST ‍, ALP ‍, GGT ‍, Bilirubin ‍, Albumine ‍, INR ‍



Associated symptoms: *Try using right-click for negatives*

‍fatigue

‍nausea

‍loss of appetite

‍unexpected weight loss

‍fever, up to ‍°, over ‍ ‍hoursdays

‍abdominal swelling

‍abdominal pain, ‍diffuse, ‍dull, ‍mild

‍jaundice

‍leg swellings

‍dark colored urine

‍dark, tarry stool



Contributing factors:

‍obesity

‍high fat diet

‍high alcohol consumption

‍travel to high-risk areas

‍unsafe sexual intercourse

‍tattoos

‍history of injection drugs

‍sharing of needles

no history of: ‍viral hepatitis, ‍hemochromatosis, ‍cirrhosis, ‍autoimmune diseases, ‍steatohepatitis

no use of: ‍acetaminophen, ‍statin, ‍antibiotics, ‍antifungals, ‍immunosuppressants, ‍chemotherapy drugs, ‍herbal supplements

no family history of: ‍liver diseases





EXAM:

General appearance: ‍well-appearing, ‍apparent distress

Vital signs: ‍normal, BP ‍, HR ‍, RR ‍, SpO2 ‍ %, Temp ‍°

Neck: ‍normal, ‍lymphadenopathy, ‍, c-spine ‍

Heart: ‍RRR, ‍MRG, ‍normal S1 and S2

Lungs: ‍clear bilaterally, ‍abnormal sounds, ‍retractions

Abdomen: ‍soft, ‍non-tender ‍, ‍non-distended, ‍guarding, bowel sounds ‍normal, ‍, ‍CVA tenderness ‍

Skin: ‍rashlesions on ‍

Extremities: ‍warm, ‍dry, cap refill ‍< 3> 3 sec, pulses ‍intact, ‍edema ‍bilaterally, ‍





ASSESSMENT:

‍Non-alcoholic fatty liver disease ‍likelysuspectedpossible

DDx: non-alcoholic fatty liver disease, alcoholic liver disease, viral hepatitis, autoimmune hepatitis, hemochromatosis, Wilson's disease, drug-induced liver injury (e.g., acetaminophen toxicity, statins), primary biliary cholangitis, primary sclerosing cholangitis, cholestasis, Gilbert's syndrome, cirrhosis, hepatic steatosis, hepatic metastases, biliary obstruction (e.g., gallstones), liver abscess, liver trauma, budd-chiari syndrome, alpha-1 antitrypsin deficiency, granulomatous liver disease, schistosomiasis affecting the liver, amyloidosis affecting the liver, cystic fibrosis liver disease, celiac disease





PLAN:

Investigations:

- Blood work: ‍CBC, ‍lytes, ‍creatinine, ‍glucose, ‍Hba1c, ‍lipid profile, ‍LFTs, ‍bilirubin, ‍albumin, ‍proteins, ‍prothrombin time, ‍INR, ‍ferritin, ‍iron, ‍TIBC, ‍anti-HBs antibodies, ‍HBsAg, ‍anti-HBc antibodies, ‍anti-HCV antibodies

- Blood work (advanced): ‍anti-transglutaminase antibodies, ‍anti-mitochondrial antibodies, ‍anti-nuclear antibodies, ‍anti-smooth muscle antibodies, ‍anti-KLM antibodies, ‍alpha-1 antitrypsin, ‍ceruloplasmin

- Abdominal ultrasound

- Liver biopsy

Treatments:

- Avoidance of alcohol

- Weight loss counseling

- Dietary modifications: ‍low fat diet, ‍high fiber diet

- Reassess medications that may be causing liver damage (acetaminophen, statins, antibiotics, antifungals, immunosuppressants, chemotherapy drugs, herbal supplements)

Further care:

- Repeat LFTs in ‍ ‍daysweeks

- Referral to gastroenterologist

- Referral to hepatologist

- Follow-up in ‍ ‍daysweeksmonths

- Return if symptoms worsen or if new symptoms develop such as jaundice, abdominal pain, or fever