1/
Misnomers in medicine and few pearls re: AST/ALT, ALP/Bili
Let us eradicate the term LFTs as NONE of these enzymes measure function.
Let us eradicate the term “transaminitis” as enzymes cannot be inflamed (e.g., say “troponitis” to a cardiologist).
Misnomers in medicine and few pearls re: AST/ALT, ALP/Bili
Let us eradicate the term LFTs as NONE of these enzymes measure function.
Let us eradicate the term “transaminitis” as enzymes cannot be inflamed (e.g., say “troponitis” to a cardiologist).
2/
Liver Chemistry Tests (LCTs), not LFTs
Describe the inflammatory pattern, not “transaminitis”
Liver Chemistry Tests (LCTs), not LFTs
Describe the inflammatory pattern, not “transaminitis”
3/
Three critical questions re: LCTs: (1) pattern, (2) severity, and (3) tempo
Three critical questions re: LCTs: (1) pattern, (2) severity, and (3) tempo
4/
Patterns: (1) AST/ALT predominant, (2) ALP/Bili (direct) predominant, (3) Mixed, (4) Liver-specific ALP predominant
For practice, try to interpret LCTs in the case and then listen to the best dissection of LCTs by @rabihmgeha, Minute 26 bit.ly/2xz0bNC
Patterns: (1) AST/ALT predominant, (2) ALP/Bili (direct) predominant, (3) Mixed, (4) Liver-specific ALP predominant
For practice, try to interpret LCTs in the case and then listen to the best dissection of LCTs by @rabihmgeha, Minute 26 bit.ly/2xz0bNC
5/
Once you label the inflammation as a hepatocellular pattern, dive deeper
AST present in many cells while AL(iver)T more specific to liver
AS(horter)T has a shorter half-life than AL(onger)T
Once you label the inflammation as a hepatocellular pattern, dive deeper
AST present in many cells while AL(iver)T more specific to liver
AS(horter)T has a shorter half-life than AL(onger)T
6/
AST > ALT must consider extrahepatic causes, but even when the ratio is similar must consider chronic extrahepatic inflammation (eg. myositis) b/c AST will decrease faster than ALT (send a CK if a patient is weak) @AmitGoyalMD pearl
@rabihmgeha bit.ly/2VB5LXA
AST > ALT must consider extrahepatic causes, but even when the ratio is similar must consider chronic extrahepatic inflammation (eg. myositis) b/c AST will decrease faster than ALT (send a CK if a patient is weak) @AmitGoyalMD pearl
@rabihmgeha bit.ly/2VB5LXA
7/
Historically AST/ALT level > 1000 thought to result from a virus, ischemia, and drugs. @tonybreu put conventional wisdom to the test and revealed biliary obstruction (large stone) among leading cause bit.ly/2xyPQ4f
Historically AST/ALT level > 1000 thought to result from a virus, ischemia, and drugs. @tonybreu put conventional wisdom to the test and revealed biliary obstruction (large stone) among leading cause bit.ly/2xyPQ4f
8/
@rabihgeha taught us the importance of tempo in diagnosis. No different here. Rapidly resolving AST/ALT increase the likelihood of transient pathology (restored blood flow in ischemia, passed stone in biliary obstruction)
@rabihgeha taught us the importance of tempo in diagnosis. No different here. Rapidly resolving AST/ALT increase the likelihood of transient pathology (restored blood flow in ischemia, passed stone in biliary obstruction)
9/
LCTs not LFTs
Pattern of liver inflammation not transaminitis
Pattern, severity, and tempo will help localize the lesion
LCTs not LFTs
Pattern of liver inflammation not transaminitis
Pattern, severity, and tempo will help localize the lesion
10/
Have a lovely day. Exercise. Sleep as much as you can. Stay connected with your friends and family.
Have a lovely day. Exercise. Sleep as much as you can. Stay connected with your friends and family.
