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liver disease
Includes diseases of the liver.
Laboratory:
- prolonged protrombin time
- prolonged aPTT
- serum albumin low
- plasma fibrinogen is low & possibly dysfunctional
- complete blood count (CBC)
- iron studies
- serum ferritin (rule out hemochromatosis)
- urinalysis
- tyrosine crystals in urine, may occur with leucine crystals in urine
- see ARUP consult [2]
* also see cirrhosis
Differential diagnosis:
- hepatocellular disease
- hepatocellular injury results in elevated serum AST & serum ALT
- viral hepatitis or drug hepatitis results in serum AST & serum ALT > 1000 U/L (with serum ALT > serum AST) & serum bilirubin (total) > 15 mg/dL
- serum ALT > 5000 U/L suggest acetaminophen toxicity or hepatic ischemia
- serum AST/ALT > 2.0 suggests alcoholic hepatitis
- prolonged PT/INR & low serum albumin suggest hepatocellular dysfunction
- minimal serum AST & serum ALT in patients with obesity & hyperlipidemia suggest non-alcoholic fatty liver disease (NAFLD) [1]
- hepatobiliary disease
- increased serum bilirubin
- increased serum alkaline phosphatase
- lesser (than hepatocellar) elevations in serum AST & serum ALT [1]
Management:
- coagulopathy of liver disease
- vitamin K
- cryoprecipitate to maintain plasma fibrinogen > 10 mg/dL
- platelet transfusions to achieve latelet count > 75,000/uL [1]
- utility of fresh frozen plasma limited by short 1/2life of coagulation factors & risk of volume overload [1]
- prothrombin concentrates not recommended because of cost & prothrombotic complications [1]
Related
hospice guidelines for determining prognosis, liver disease
liver
Specific
alcoholic liver disease (ALD)
bilirubin metabolism, inborn error
breast milk jaundice
chronic liver disease
coagulopathy of liver disease
congenital bile acid synthesis defect
end-stage liver disease (ESLD)
focal nodular hyperplasia (liver)
hepatic abscess
hepatic congestion; cardiac cirrhosis
hepatic cyst
hepatic fibrosis
hepatic infarction
hepatic injury
hepatic necrosis
hepatic vein thrombosis (Budd-Chiari syndrome)
hepatic veno-occlusive disease; sinusoidal obstruction syndrome
hepatitis
hepatobiliary infection
hepatomegaly
hepatoptosis
hepatopulmonary syndrome
hepatorenal syndrome; acute kidney injury in cirrhosis
hepatotoxicity
hydrohepatosis
liver (hepatic) failure/insufficiency
liver disease during pregnancy
liver hemorrhage
liver mass
liver neoplasm
peliosis hepatis
portal hypertension
portal pyemia
portal vein thrombosis
Reye's syndrome
Tangier disease; high density lipoprotein (HDL) deficiency type 1; analphalipoproteinemia (HDLD1)
Weil's syndrome
Zellweger syndrome; cerebrohepatorenal syndrome
General
digestive system disease
References
- Medical Knowledge Self Assessment Program (MKSAP) 17, 18,
American College of Physicians, Philadelphia 2015, 2018,
- Medical Knowledge Self Assessment Program (MKSAP) 19
Board Basics. An Enhancement to MKSAP19.
American College of Physicians, Philadelphia 2022
- ARUP Consult: Liver Disease Evaluation
The Physician's Guide to Laboratory Test Selection & Interpretation
https://www.arupconsult.com/content/liver-disease-evaluation
- Liver Disease or Hepatitis of Unknown Etiology Testing Algorithm
https://arupconsult.com/algorithm/liver-disease-or-hepatitis-unknown-etiology-testing-algorithm