Description 🎙️
Mike presents a case of severely elevated transaminases in a patient with abdominal pain & fevers. The social history is king here, & it isn't the only king in the room…
Teaching ✍️
- Severe Acute Hepatocellular Injury (”transaminosis”): the DDx for acute hepatocellular injury can be grouped into 3 buckets (Plumbing, Pregnancy-related, Parenchymal disorders), & this DDx can be supplemented by putting an asterisk over those diseases that can cause severely elevated AST & ALT (i.e. > 1,000 U/L).
- Filtering the filter: of the asterisk’d diseases, those diseases that lead to hepatocyte release of AST & ALT via necrosis lead to a much more impressive rise (e.g. > 2,000 U/L) than those diseases that lead to release via apoptosis. Necrosis is generally related to ischemia (i.e. ischemic hepatitis) & toxins (e.g. DILI). Apoptosis is seen in metabolic disorders (e.g. Wilson’s crisis): the severity of AST & ALT elevation in these disorders is generally lesser (e.g. < 2,000 U/L).
