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=Gallstone Disease=
==Gallstone Disease==
*H&P:
*H&P:
*Dx: Cholestatic pattern of '''elevated bilirubin and alk phos''', Charcot triad for '''ascending cholangitis includes RUQ pain, fever, jaundice'''. When clinical suspicion for acute cholecystitis is high, but US is negative or inconclusive, '''get HIDA scan.'''
*Dx: Cholestatic pattern of '''elevated bilirubin and alk phos''', Charcot triad for '''ascending cholangitis includes RUQ pain, fever, jaundice'''. When clinical suspicion for acute cholecystitis is high, but US is negative or inconclusive, '''get HIDA scan.'''
*Tx: For acute/ascending cholangitis, treat with '''ERCP within 24-48 hrs'''
*Tx: For acute/ascending cholangitis, treat with '''ERCP within 24-48 hrs'''
=Viral and Non-viral Hepatitis=
==Viral and Non-viral Hepatitis==
*H&P:
*H&P:
*Dx: '''HBsAg, HBeAg, HBV DNA, and ALT''' are elevated during the early symptomatic phase of infection. In later stages '''anti-HBs, anti-HBe, and total anti-HBc''' are all elevated. In the window period, only '''IgM anti-HBc and anti-HBe''' will be elevated.
*Dx: '''HBsAg, HBeAg, HBV DNA, and ALT''' are elevated during the early symptomatic phase of infection. In later stages '''anti-HBs, anti-HBe, and total anti-HBc''' are all elevated. In the window period, only '''IgM anti-HBc and anti-HBe''' will be elevated.
*Tx:
*Tx:
=Cirrhosis and Ascites=
==Cirrhosis and Ascites==
*H&P:
*H&P:
*Dx: Calculate SAAG, if ≥ 1.1, '''think portal hypertension (from CHF, cirrhosis, EtOH hepatitis)'''; if < 1.1, '''think cancer, pancreatitis, nephrotic syndrome'''.
*Dx: Calculate SAAG, if ≥ 1.1, '''think portal hypertension (from CHF, cirrhosis, EtOH hepatitis)'''; if < 1.1, '''think cancer, pancreatitis, nephrotic syndrome'''.
*Tx:
*Tx:
=Acetaminophen Toxicity=
==Acetaminophen Toxicity==
*H&P:
*H&P:
*Dx:
*Dx:
*Tx:
*Tx:
=Heredity Hemochromatosis=
==Heredity Hemochromatosis==
*H&P: Males present young (30s), Females present late (60s), '''hyperpigmentation''', arthritis, cardiomyopathy, diabetes
*H&P: Males present young (30s), Females present late (60s), '''hyperpigmentation''', arthritis, cardiomyopathy, diabetes
*Dx: Elevated AST and ALT, serum ferritin and transferrin saturation, HFE gene mutation
*Dx: Elevated AST and ALT, serum ferritin and transferrin saturation, HFE gene mutation
*Tx: Therapeutic phlebotomy
*Tx: Therapeutic phlebotomy
=Wilson Disease=
==Wilson Disease==
*H&P: Age < 35 with neuropsychiatric symptoms (depression, movement disorders) and hepatomegaly
*H&P: Age < 35 with neuropsychiatric symptoms (depression, movement disorders) and hepatomegaly
*Dx: Elevated AST and ALT
*Dx: Elevated AST and ALT
*Tx:
*Tx:
=α1-Antitrypsin Disease=
==α1-Antitrypsin Disease==
*H&P: Associated with emphysema
*H&P: Associated with emphysema
*Dx: Elevated AST and ALT
*Dx: Elevated AST and ALT
*Tx:
*Tx:
=Autoimmune Hepatitis=
==Autoimmune Hepatitis==
*H&P: Young to middle-aged; F>M; Painless hepatomegaly
*H&P: Young to middle-aged; F>M; Painless hepatomegaly
*Dx: Elevated AST and ALT, normal ALK and TBili. '''ANA and anti smooth muscle''' antibodies are positive.
*Dx: Elevated AST and ALT, normal ALK and TBili. '''ANA and anti smooth muscle''' antibodies are positive.
*Tx:
*Tx:
=PBC=
==PBC==
*H&P: Age 30-65, F>M; Fatigue and jaundice; Associated with osteoporosis
*H&P: Age 30-65, F>M; Fatigue and jaundice; Associated with osteoporosis
*Dx: Positive AMA, elevated ALK, mildly elevated AST and ALT
*Dx: Positive AMA, elevated ALK, mildly elevated AST and ALT
*Tx: Ursodeoxycholic acid
*Tx: Ursodeoxycholic acid
=PSC=
==PSC==
*H&P:
*H&P:
*Dx:
*Dx: