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Liver Tests
What is the most specific liver test? AST, ALT, ALP, or albumin Aminotransferases AST and ALT are liver enzymes that catalyze transfer of amino groups in gluconeogenesis. AST catalyzes the transfer of an amino group from aspartic acid to ketoglutaric acid to produce oxaloacetic acid. ALT catalyzes the transfer of an amino group from alanine to ketoglutaric acid to produce pyruvic acid. AST is found in many tissues including the liver, skeletal muscle, cardiac muscle, kidney, brain, pancreas, lungs and red blood cells. ALT is found mainly in the liver and is more specific for liver disease than AST. Alkaline phosphatase ALP is found in the liver, but also in…
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Child-Turcotte-Pugh (CTP) score
The CTP score is used to predict surgical risks in patients with cirrhosis when undergoing intra-abdominal operations. Child-Turcotte-Pugh (CTP) Score Variable 1 point 2 points 3 points Bilirubin < 2 mg/dL 2-3 mg/dL > 3 mg/dL Albumin >3.5 g/dL 2.8-3.5 g/dL
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Acalculous Cholecystitis
What causes acalculous cholecystitis? The gallbladder in acalculous cholecystitis has stasis of bile within it and is also hypoperfused leading to inflammation (cholecystitis). By definition it is cholecystitis that occurs without a gallstone being present in the gallbladder. What are some risk factors for developing acalculous cholecystitis? Acalculous cholecystitis is typically seen in patients that are critically ill. Risk factors include: immunosuppression recent surgery total parenteral nutrition (TPN) sepsis hypotension How is the diagnosis of acalculous cholecystitis made? The diagnosis is made based on findings in the history and physical exam along with laboratory tests and imaging. Suspect acalculous cholecystitis in patients with risk factors (recent surgery, TPN, etc) who have…
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Manometry
Esophageal manometry is an accurate method for assessing esophageal motility disorders including achalasia, diffuse esophageal spasm and scleroderma affecting the esophagus.
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Dysphagia Qs
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Esophagus in Scleroderma
IM→GI→Esophagus→Motility Disorders→Scleroderma A 35 year old African American woman presents to your clinic with difficulty swallowing and heart burn. History reveals a diagnosis of scleroderma. Pathology: Scleroderma causes diffuse fibrosis of the esophagus which results in loss of LES (lower esophageal sphincter) function as well as absent peristalsis of smooth muscle in the distal esophagus. Presentation: Patients present with dysphagia as well as GERD. They will have history of scleroderma, look for a description of Raynaud’s phenomenon. Diagnosis: Manometry will show hypotensive/ absent peristalsis and LES tone. Management: Proton pump inhibitors (PPIs).
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Diffuse esophageal spasm (DES)
A 32 year old comes to your clinic complaining of difficulty swallowing with solids, as well as both hot and cold liquids. This has been happening intermittently for about a week. Pathology Impaired innervation of the esophagus –> uncoordinated simultaneous contractions (non-peristaltic). This primarily affects the distal esophagus, so this condition is also called Distal Esophageal Spasm (DES). Presentation Spontaneous odynophagia and dysphagia with both solids and liquids. May be described as “chest pain” when eating. Often precipitated by emotional stress. The chest pain is relieved by nitroglycerin and calcium channel blockers — they relax the esophageal myocytes. They often have regurgitation of food. Key features: – progressive dysphagia to…
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Achalasia