Source / episode info
- **Episode:**212
- **Title:**Divine Intervention Episode 212 – Family Medicine Shelf Review Series 3 (GI).
- **Published:**2020-02-13
- Source:Episode page
One-liner
Episode 212 provides a comprehensive review of liver pathology, covering the differentiation between hepatocellular and cholestatic patterns; detailing viral hepatitis serologies (A and B); outlining management of cirrhosis complications (bleeding, encephalopathy, HRS); and comparing autoimmune cholangitis syndromes like PBC and PSC.
High-yield summary
- Liver Injury Patterns: Hepatocellular pattern involves disproportionately elevated AST/ALT; Cholestatic pattern involves disproportionately elevated ALP/GGT. The ratio of direct to total bilirubin is key for diagnosis.
- Hepatitis Serology (Hep B): Positive HBsAg indicates infection. Anti-HBc IgM suggests acute infection, while anti-HBc IgG suggests past or chronic exposure. A positive anti-HBs alone usually means vaccination or recovery.
- Cirrhosis Management: Screening for Hepatocellular Carcinoma (HCC) is mandatory every six months via ultrasound in all cirrhotic patients.
- Autoimmune Cholangitis: PBC affects middle-aged women (40–60 years old), presents with positive Anti-Mitochondrial Antibodies (AMA), and involves intrahepatic ducts. PSC affects younger men, is associated with IBD (especially UC), and can involve both intra- and extrahepatic ducts.
- Liver Failure Syndromes: Hepato-renal Syndrome (HRS) results from splanchnic vasodilation leading to a pre-renal pattern of AKI; Acute Fatty Liver of Pregnancy (AFLP) is a critical, acute third-trimester complication requiring immediate delivery.
Learning objectives
- Differentiate between hepatocellular and cholestatic patterns of liver injury using enzyme ratios (AST/ALT vs. ALP/GGT).
- Recognize the clinical presentation, serology, and management protocols for Hepatitis A and B infections.
- Master the screening guidelines and differential diagnosis for chronic cholangitis syndromes (PBC vs. PSC).
- Understand the pathophysiology and acute management of liver failure complications, including HE, HRS, and AFLP.
- Identify classic signs and symptoms associated with iron overload disorders like Hemochromatosis.
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