There are five major groups of inherited defects in bilirubin metabolism: Gilbert’s syndrome, Crigler-Najjar syndrome (type I), Arias syndrome (Crigler-Najjar syndrome type II), Dubin-Johnson syndrome, and Rotor syndrome. Gilbert’s syndrome. Gilbert’s syndrome is a congenital partial defect in unconjugated bilirubin clearance due to decreased function of the enzyme bilirubin uridine diphosphate-glucuronate glucuronyl transferase (UDP-GT). Males […]
A few comments on the use of liver function tests are indicated. It is not necessary to order every test available and keep repeating them all, even those that give essentially the same information. For example, the ALT is sometimes useful in addition to the AST either to establish the origin of an increased AST […]
This section will review several typical patterns of laboratory values found in liver disease, with their differential diagnosis: 1. An AST value greater than 20 times the upper reference limit. If the AST increase is due to liver disease rather than heart or skeletal muscle injury, this suggests acute hepatitis virus hepatitis. Less common etiologies […]
Metastatic tumor to the liver may be completely occult or may produce a clinical or laboratory picture compatible with hepatomegaly of unknown origin; normal liver with elevated ALP levels simulating bone disease; active cirrhosis; or obstructive jaundice. The liver is a frequent target for metastases, some of the most common primary sites being lung, breast, […]
The most common etiologies of portal cirrhosis are alcohol, hepatitis virus, or unknown (cryptogenic) cause. Less common causes are primary biliary cirrhosis and genetically related cirrhosis (Wilson’s disease, hemochromatosis, and alpha-1 antitrypsin deficiency). Cirrhosis exhibits a wide spectrum of test results, depending on whether the disease is active or inactive and on the degree of […]
Fatty liver is a common cause of hepatomegaly of unknown etiology. In uncomplicated fatty liver, function tests are variable. There may be no abnormality at all. ALP levels in one series were elevated in nearly 48% of patients but usually were less than twice normal. An elevated AST level is found in 40% of patients, […]
Primary biliary cirrhosis is an uncommon type of biliary obstruction that should be briefly mentioned. It occurs predominantly in young or middle-aged women and typically is a slow process. On liver biopsy there is inflammation and destruction of small bile ducts within liver portal areas. Clinically there is pruritus with or without mild jaundice. Steatorrhea […]
Obstruction may be complete or incomplete, extrahepatic or intrahepatic. Extrahepatic obstruction is most often produced by gallstones in the common bile duct or by carcinoma of the head of the pancreas. Intrahepatic obstruction is most often found in the obstructive phase of acute hepatocellular damage, as seen in “active” alcoholic cirrhosis, hepatitis virus hepatitis, in […]
Hepatitis virus B will be used as a model here. After an incubation period, acute viral hepatitis most often begins with some combination of GI tract symptoms, fever, chills, and malaise, lasting 4-7 days. During this phase there is no clinical jaundice. Leukopenia with a relative lymphocytosis is common, and there may be a few […]
This procedure has been greatly simplified, and its morbidity and mortality markedly reduced, by the introduction of small-caliber biopsy needles such as the Menghini. Nevertheless, there is a small but definite risk. Relative contraindications to biopsy include a PT in the anticoagulant range or a platelet count less than 50,000/mm3. Liver biopsy is especially useful […]
