3 Young Patients with Symptoms of Hepatic Disease: A 3-case GI Quiz
A 28-y/o who is pregnant with first child; a 39-y/o with hypothroidism; and a 25-y/o with 3 days of severe abdominal pain. Please diagnose and treat.
#1. A 28-year-old woman who is 32-weeks pregnant with her first child presents with altered mental status, jaundice, and elevated INR. Biopsy of the liver demonstrates microvesicular steatosis and she is diagnosed with acute fatty liver of pregnancy. Transplant evaluation is initiated.
In which of the scenarios above does this condition occur?
#1. Answer: B. Mother is heterozygous for LCHAD deficiency, fetus is homozygous for the deficiency.
#2. A 39-year-old woman with a history of hypothyroidism presents with elevated liver enzymes. Her AST is 1000 U/L, ALT 800 U/L, PT 1.3, total bilirubin 3.1. Liver ultrasound demonstrates an echogenic liver and results of the Doppler ultrasound are normal. Testing for viral hepatitis is negative. Results of liver biopsy are consistent with autoimmune hepatitis.
#2. What is the next best step in management?
#2. Answer: E. Start prednisone 30 mg/day and azathioprine 50 mg/day.
#3. A 25-year-old man presents to the ED with 3 days of progressive abdominal pain and distention. He has been afebrile and denies nausea, vomiting, melena, or hematochezia. He has no significant past medical history. He is alert and oriented and has shifting abdominal dullness with hepatomegaly on examination.
What is the most likely diagnosis?
#3. Answer: B. Budd-Chiari syndrome
