Adam and Alex introduce Decompensated: the official podcast of Liver Fellow Network! In this short teaser, we outline our goals for the podcast and prove to ourselves that we just might be able to edit a podcast.
The clinical and histologic presentation of autoimmune hepatitis (AIH) can be quite variable. Here, we present the microscopic features of AIH and discuss clinicopathologic findings that can be used to narrow the differential diagnosis, including the criteria proposed by the International Autoimmune Hepatitis Group.
A 28-year-old woman presents with progressive right upper quadrant pain, fever, and non-productive cough. She is 32 weeks pregnant. On admission she is febrile to 39°C and her physical examination is notable for right upper quadrant tenderness as well as a gravid uterus. She has no scleral icterus. Her lungs are clear. She has no visible oral or genital lesions or skin rashes on examination. She is not encephalopathic. She only takes folic acid and denies taking any other medications. She does not drink alcohol or use illicit drugs. She has not had any recent travel. Her labs on admission are WBC 2.8, Hct 30, Plts 85, ALT 9678, AST 8756, ALP 150, Tbili 1.4, INR 1.8. A Tylenol level is undetectable. Hepatitis A, B, and C testing are negative. A pelvic ultrasound shows a viable fetus. A doppler ultrasound of the liver is normal. What is the next best step in management?
In part 2 of our coagulopathy series, we take a deeper dive and learn the ways in which end-stage liver disease alters the body’s normal hemostatic mechanisms.
In patients with unresectable HCC, what is the best systemic therapy? https://www.nejm.org/doi/full/10.1056/NEJMoa1915745