GI Bleeding

Upper GI Bleeding:  Patients with acute upper gastrointestinal (GI) bleeding commonly present with hematemesis (vomiting of blood or coffee-ground like material) and/or melena (black, tarry stools). The initial evaluation of patients with acute upper GI bleeding involves an assessment of hemodynamic stability and resuscitation if necessary.     Etiology:  The most common causes of upper gastrointestinal bleeding include … Read more

Acute Liver failure

Acute Liver Failure: Acute liver failure is characterized by acute liver injury, hepatic encephalopathy, and an elevated PT/INR. It has also been referred to as fulminant hepatic failure, acute hepatic necrosis, fulminant hepatic necrosis, and fulminant hepatitis.   Acute liver failure refers to the development of severe acute liver injury with encephalopathy and impaired synthetic … Read more


Jaundice Definition Yellowish discoloration of tissue, also called icterus, resulting from the deposition of bilirubin, which occurs only in the presence of serum hyperbilirubinemia. Jaundice is not usually detected until the serum bilirubin level exceeds 3.0 mg/dL. Although usually a sign of significant disease, many persons have a congenital predisposition to mild jaundice (e.g., Gilbert’s syndrome) … Read more

Hepatic Encephalopathy

Hepatic encephalopathy Hepatic encephalopathy or portosystemic encephalopathy is a syndrome of neuropsychiatric dysfunction caused by portosystemic venous shunting, with or without liver disease, but primarly occurring in patients with advanced liver failure.   Pathogenesis:   Ammonia is the primary neurotoxin that precipitates hepatic encephalopathy. The increase in blood ammonia in advanced liver disease is a consequence … Read more

Abnormal Liver tests

Liver Function Tests Tests that measure detoxification or excretory functions Serum bilirubin Urine bilirubin Blood ammonia Serum enzymes that reflect damage to hepatocytes Alanine aminotransferase (ALT) Aspartate aminotransferase (AST) Serum enzymes that reflect cholestasis  Alkaline phosphatase (AP) 5′-nucleotidase Gamma glutamyl transpeptidase (GGT) Tests that measure biosynthetic liver function Serum albumin Serum globulins Beta globulins Alpha … Read more