liver disease
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Introduction
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]
- hepatocellular injury results in elevated serum AST & serum ALT
- 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]
More general terms
More specific terms
- 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
Additional terms
References
- ↑ 1.0 1.1 1.2 1.3 1.4 1.5 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
Medical Knowledge Self Assessment Program (MKSAP) 20 American College of Physicians, Philadelphia 2025 - ↑ 2.0 2.1 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 - ↑ Biggins SW, Angeli P, Garcia-Tsao G, et al. Diagnosis, evaluation, and management of ascites, spontaneous bacterial peritonitis and hepatorenal syndrome: 2021 practice guidance by the American Association for the Study of Liver Diseases. Hepatology. 2021;74:1014-1048. PMID: https://pubmed.ncbi.nlm.nih.gov/33942342