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Old 08-19-2012
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Default liver injury... cholestasis vs hepatocellular

q...had these values...
Bilirubin (total) 4.6 mg/dL (78.7 μmol/L)
Bilirubin (direct) 3.5 mg/dL (59.9 μmol/L)
Aspartate aminotransferase 1123 U/L
Alanine aminotransferase 1350 U/L
Alkaline phosphatase 185 U/L
Which of the following patterns of hepatic injury is present?
(A) Cholestatic injury
(B) Hepatocellular injury
(C) Mixed hepatocellular and cholestatic injury
(D) Nonhepatic injury pattern (muscle injury)

ans given is B . but couldnt this be C because direct to total brb is more than 50% and ALP also elevated. please reply.
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Old 08-19-2012
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I think swelling of hepatocytes from injury and inflammation causing obstruction of bile canaliculi leading to build up of conj bilirubin , as well as increase Unconj bilir due to decrease capacity of the damage liver to conj the bilirubin .
correct me if i am wrong .

Last edited by heartbeat; 08-19-2012 at 12:28 PM.
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Old 08-19-2012
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Patterns of drug-induced liver disease

Type of injury:........... Hepatocellular............... Cholestatic..................... Mixed
ALT........................ ≥ Twofold rise.................... Normal.................. ≥ Twofold rise
ALP ............................. Normal................. ≥ Twofold rise ...............≥ Twofold rise
ALT: ALP ratio.................. High,≥5...................... Low, ≤2...................... 2-5

Quote:
Liver injury is defined as a rise in either (a) ALT level more than three times of upper limit of normal (ULN), (b) ALP level more than twice ULN, or (c) total bilirubin level more than twice ULN when associated with increased ALT or ALP.[18][19] Liver damage is further characterized into hepatocellular (predominantly initial Alanine transferase elevation) and cholestatic (initial alkaline phosphatase rise) types. However they are not mutually exclusive and mixed types of injuries are often encountered.

Last edited by Novobiocin; 08-19-2012 at 12:32 PM.
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