Todays case presented a patient with mixed LFT abnormalities and painless jaundice without evidence of extrahepatic biliary obstruction. AST/ALT elevated >400, AlkPhos >500, bili >18.
Differentials discussed included drug induced liver disease, ? recent antibiotic exposure,
This page from NIH has a good breakdown of the varying patterns of drug induced liver disease, including the predominantly cholestatic pattern and the mixed pattern.
The clinical/pathological syndrome of "granulomatous hepatitis" - expanded upon in this presentation - was also discussed, though does not usually lead to the degree of bilirubin elevations noted in this case. The linked presentation walks through a good differential of this condition based on pathological or epidemiological risk factors present in the case.
Lastly, acute hepatitis C is a possibility to be considered. Interestingly - a robust immune response is generally required to trigger symptomatic disease and jaundice, and this subset of patients (presenting with jaundice) have a lower rate of development of chronic hepatitis C infection.
And from noon conference - the noon conference on Sjogren's syndrom brought to mind this image from NEJM, which made an appearance in a prior Quiz Bowl and is likely to make an appearance at a future showing,
Review of topics covered in morning report, M&m, and core conferences with links to supplemental reading material.
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