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Author 5 Posts
James
Senior Member

Topics: 14
Posts: 127
Posted 12/13/11 - 02:29 AM report   #1
NASH (Non alcoholic steato-hepatitis)

The typical patient is over 40 and has diabetes, obesity and elevated ALT.

Certainly, one would already have ruled out other causes of hepatitis like the viral etiologies, SLE, auto-immune hepatitis, drug induced hepatitis, alcoholic hepatitis etc.

60% of such patients will have NASH.

Weight loss must be encouraged. In 3-6 months recheck ALT. If still elevated, proceed to biopsy. Necrosis of parenchyma may be obvious.
James
Senior Member

Topics: 14
Posts: 127
Posted 12/13/11 - 02:31 AM report   #2
In alcoholic liver disease, Tylenol toxicity, and ischemic hepatitis the AST is elevated more than the ALT. (AST:ALT ~ 2). GGT is a more sensitive indicator of alcohol intake thus in a patient with elevated AST but normal GGT - alcohol is unlikely to be the etiology)
James
Senior Member

Topics: 14
Posts: 127
Posted 12/13/11 - 02:32 AM report   #3
We are all aware of Chronic hepatitis B being a strong risk factor for hepatocellular carcinoma but what is not well known is that these patients should undergo surveillance for it by ultrasound / doppler and Alfa fetoprotein check every 6 months.

This practice detects tumors early and allows for treatment but has not yet shown to improve survival.
James
Senior Member

Topics: 14
Posts: 127
Posted 12/13/11 - 02:40 AM report   #4
Gilbert's disease- Jaundice that is mild and occurs on starving/stress e.g. Pre-op NPO(NBM) or during religious rituals of fasting e.g. Ramadan. It is a benign condition due to hereditary deficiency of the enzyme Glucuronyl transferase. therefore conjugation is deficient and unconjugated bilirubin is elevated. A 2 day half (1200-1300) calorie diet increases Bili by 1.5 mg%.
James
Senior Member

Topics: 14
Posts: 127
Posted 12/13/11 - 02:41 AM report   #5
Antiviral therapy is recommended for patients with chronic hepatitis C who are at greatest risk for progression to cirrhosis. These persons include anti-HCV-positive patients with persistently elevated ALT levels, detectable HCV RNA, and a liver biopsy that indicates either portal or bridging fibrosis or at least moderate degrees of inflammation and necrosis. (Making a liver biopsy almost necessary to do before treating)








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