Changes

=Approach to LFTs=

=Approach to LFTs=

GGT measurement helps differentiate if elevated '''alk phos is from liver (elevated) or bone (normal)'''

*Dx: GGT measurement helps differentiate if elevated '''alk phos is from liver (elevated) or bone (normal)'''

{| class="wikitable"

{| class="wikitable"

==Wilson Disease==

==Wilson Disease==

*H&P: Age < 35 with neuropsychiatric symptoms (depression, movement disorders) and hepatomegaly

*H&P: Age < 35 with neuropsychiatric symptoms (depression, movement disorders) and hepatomegaly

*Dx: Elevated AST and ALT

*Dx: Elevated AST and ALT; liver biopsy, or genotyping (ATP7a gene)

*Tx:

*Tx: Lifelong chelation (penicillamine, trientine), high dose PO zinc, transplant

==α1-Antitrypsin Disease==

==α1-Antitrypsin Disease==

*H&P: Associated with emphysema  

*H&P: Associated with emphysema, young non-smokers

*Dx: Elevated AST and ALT

*Dx: Elevated AST and ALT, serum AAT levels, genotyping

*Tx:

*Tx: Transplant, AAT augmentation

==Autoimmune Hepatitis==

==Autoimmune Hepatitis==

*H&P: Young to middle-aged; F>M; Painless hepatomegaly

*H&P: Young to middle-aged; F>M; painless hepatomegaly

*Dx: Elevated AST and ALT, normal ALK and TBili. '''ANA and anti smooth muscle''' antibodies are positive.

*Dx: Elevated AST and ALT, normal ALK and TBili. '''ANA, anti smooth muscle, LKMA''' antibodies are positive. Biopsy.

*Tx:

*Tx: Corticosteroids and azathioprine

==PBC==

==PBC==

*H&P: Age 30-65, F>M; Fatigue and jaundice; Associated with osteoporosis

*H&P: Age 30-65; F>M; Fatigue and jaundice; pruritis and osteoporosis; associated with hypothyroid and arthritis

*Dx: Positive AMA, elevated ALK, mildly elevated AST and ALT

*Dx: Positive AMA, elevated ALK, mildly elevated AST and ALT

*Tx: Ursodeoxycholic acid

*Tx: Ursodeoxycholic acid, cholestyramine, fat-soluble vitamins; transplant in rare cases

==PSC==

==PSC==

*H&P:

*H&P: Age 30-40; M>F; associated with IBD (UC>Crohn's); asymptomatic or presenting with fatigue, pruritic, RUQ pain

*Dx:

*Dx: Elevated ALK and bili, '''ANA, anti smooth muscle, anti pANCA''' antibodies.

*Tx:

*Tx: Ursodeoxycholic acid, cholestyramine, fat-soluble vitamins; transplant '''frequently''' required

=Missed Concepts=

=Missed Concepts=

*Food protein-induced allergic proctocolitis shows up at 1-4 weeks of age with blood and mucus streaked stools. Treat by eliminating dairy from the maternal diet. It is benign and self-limited.

*Food protein-induced allergic proctocolitis shows up at 1-4 weeks of age with blood and mucus streaked stools. Treat by eliminating dairy from the maternal diet. It is benign and self-limited.

*The shortest interval for repeat colonoscopy is for '''large adenomas (>2 cm) removed piecemeal'''. Second shortest interval is '''1 year for > 10 adenomas'''.

*The shortest interval for repeat colonoscopy is for '''large adenomas (>2 cm) removed piecemeal'''. Second shortest interval is '''1 year for > 10 adenomas'''.