Clinical Decision Rule for Ordering Liver Function Tests in ED Patients with Abdominal Pain

Systemic Lupus Erythematosus (SLE) is a chronic multisystemic inflammatory disorder that can present with a wide array of signs and symptoms. Hepatic involvement is commonly limited to a subclinical biochemical transaminitis while clinically significant liver disease is rare. A case of a 22-year-old female who presented with abdominal pain, fevers, arthralgia, and several hepatic hypodense lesions with normal liver function tests is reported in this study. She failed to improve with antibiotics and infectious workup was largely unrevealing. She was found to have a positive ANA, high titers of anti-double-stranded DNA antibody, and was ultimately diagnosed with new-onset SLE with hepatic aseptic micro-abscesses. Her symptoms were self-limiting, and she was later started on a low-dose prednisone taper and hydroxychloroquine. This case demonstrates that hepatic involvement, despite normal liver function tests, should be considered in SLE patients presenting with abdominal pain.

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Routine monitoring of liver function tests in lung cancer resections – a necessary burden?

Scottish Medical Journal ◽

10.1177/0036933018823488 ◽

2019 ◽

Vol 64 (3) ◽

pp. 86-90

Author(s):

NA Bradley ◽

ED Kennedy ◽

M Asif

Keyword(s):

Decision Making ◽

Liver Function ◽

Clinical Decision Making ◽

Cost Effective ◽

Clinical Decision ◽

Liver Function Tests ◽

Function Tests ◽

Routine Monitoring ◽

Effective Manner ◽

Collect Patient Data

Background Increased availability of routine investigations results in significant over-investigation, burdening patients with unnecessary tests as well as increasing cost. We aimed to identify the extent of monitoring of liver function tests in lung resections, and to ascertain whether any impact on clinical decision-making occurred. Methods Cases were identified using theatre records coded as “lobectomy/bilobectomy” in the three-month period 20 June 2017 to 20 September 2017. Electronic records were used to collect patient data. Results A total of 91 cases were included; 77 (85%) patients had 1 set of pre-operative LFTs, 12 (13%) patients had 2 sets, and 2 (2%) patients had 0 sets; 69 (76%) had normal LFTs pre-operatively; 298 sets of LFTs were measured post-operatively, with a median of 3 sets per patient; 61 (67%) patients had either normal or static LFTs post-operatively, 13 (14%) had isolated rise in GGT, 16 (17%) had derangement of ALT and AST, and 1 patient (1%) had deranged ALP. Altered clinical decision-making due to LFTs derangement was recorded in two cases (2%). Conclusion Clinicians have an obligation to justify expense, and practise in a cost-effective manner. Our data suggest that the routine perioperative monitoring of LFTs in thoracic surgery does not give any clear benefit to patient care.

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Coexistence of common gallstones and sinusoidal obstruction syndrome: Case report and review of the literature

Archives of Surgery and Clinical Research ◽

10.29328/journal.ascr.1001060 ◽

2021 ◽

Vol 5 (2) ◽

pp. 020-022

Author(s):

Karahan Furkan ◽

Acar Nihan ◽

Avcı Arzu ◽

Dilek Osman Nuri

Keyword(s):

Abdominal Pain ◽

Liver Function ◽

Histopathological Examination ◽

Liver Function Tests ◽

Clinical Findings ◽

Definitive Diagnosis ◽

Sinusoidal Obstruction Syndrome ◽

Function Tests ◽

Biliary Diversion ◽

Long Time

Purpose: The sinusoidal obstruction syndrome (SOS) of the liver is an obliterative vasculitis that involves the terminal branches of the hepatic venules and sinusoids. When it is not treated, it will be a serious risk of mortality. Here, we aim to present our patient who has been associated with recurrent cholangitis attacks due to cholelithiasis and choledocholithiasis and is associated with sinusoidal obstruction syndrome with the literature. Description of the case: A 30 years old male patient had complaints of abdominal pain and nausea for a long time. The patient had a history of choledocholithiasis and cholangitis attacks. Although ERCP was performed and a stent was placed in the biliary tract, his jaundice did not disappear. Liver function tests were high. Tumor markers were negative. Methods: We could not make a definitive diagnosis with imaging methods and biopsy and we planned surgery. We performed segmental liver resection and biliary diversion in the surgery. Histopathological examination of the resected liver tissue was compatible with SOS. Conclusion: Many studies have been done on the etiology of SOS and different causes have been revealed. Accompanied with clinical findings, a definitive diagnosis is made with the exclusion of the presumptions considered. Surgery can be performed for both diagnostic and therapeutic purposes. If patients with elevated liver function tests and bilirubin have long-term abdominal pain, SOS should be bear in mind.

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