Yet its vocabulary is ... limited.
We can all tell when it is upset - high ALT, AST.
But that could mean anything!
So what's your specific patient's specific reason for high ALT?
What's the most common cause of severe acute liver injury
(ALT or AST > 10xULN)?
A few months ago, I saw someone check Parvo
Parvo is the new EBV
1. Drugs: Start NAC if tylenol! If not, NAC still ok (Fig1)
2. Acute CBD stones happen! (Fig2). Ultrasound vs MRCP --> ERCP.
3. Ischemic hepatitis... see act 2
Summary (Fig 3): Stepwise testing for severe ALI
1. Ischemic hepatitis is common and deadly.(Fig1) Often unrecognized.
2. I suspect right CHF is under-recognized. Correct me if wrong
3. While you are checking liver labs, please think about ischemic hepatitis and right HF.