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CURRENT Medical Diagnosis & Treatment 2013
Chapter 16. Liver, Biliary Tract, & Pancreas Disorders
Sections: Jaundice & Evaluation of Abnormal Liver Biochemical Tests, Diseases of the Liver, Acute Hepatitis A, Acute Hepatitis B, Acute Hepatitis C & Other Causes of Acute Viral Hepatitis, Acute Liver Failure, Chronic Viral Hepatitis, Autoimmune Hepatitis, Alcoholic Liver Disease, Drug- & Toxin-Induced Liver Disease, Nonalcoholic Fatty Liver Disease, Cirrhosis, Primary Biliary Cirrhosis, Hemochromatosis, Wilson Disease, Hepatic Vein Obstruction (Budd–Chiari Syndrome), The Liver in Heart Failure, Noncirrhotic Portal Hypertension, Pyogenic Hepatic Abscess, Benign Liver Neoplasms, Diseases of the Biliary Tract, Diseases of the Biliary Tract: Introduction, Cholelithiasis (Gallstones), Acute Cholecystitis, Pre- & Postcholecystectomy Syndromes, Choledocholithiasis & Cholangitis, Biliary Stricture, Primary Sclerosing Cholangitis, Diseases of the Pancreas, Diseases of the Pancreas: Introduction, Acute Pancreatitis, Chronic Pancreatitis.
Topics Discussed: bile duct diseases; liver diseases; pancreatic diseases.
Excerpt:"Stool and urine color are normal, and there is mild jaundice and indirect (unconjugated) hyperbilirubinemia with no bilirubin in the urine. Splenomegaly occurs in hemolytic disorders except in sickle cell anemia.The patient may be asymptomatic; cholestasis is often accompanied by pruritus, light-colored stools, and jaundice.Serum alanine and aspartate aminotransferase (ALT and AST) levels vary with age and correlate with body mass index and mortality from liver disease and inversely with caffeine consumption and possibly serum vitamin D levels. There is controversy about whether an elevated ALT level is associated with mortality from coronary artery disease, cancer, diabetes mellitus, and all causes. Normal reference values for ALT and AST are lower than generally reported when persons with risk factors for fatty liver are excluded. Truncal fat and early-onset paternal obesity are risk factors for increased ALT levels (Tables 16–3 and 16–4). Levels are mildly elevated in > 25% of persons with untreated celiac disease and in type 1 diabetic patients with so-called glycogenic hepatopathy and often rise transiently in healthy persons who begin taking 4 g of acetaminophen per day or experience rapid weight gain on a fast-food diet. Levels may..."
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