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A second vignette addresses nocturnal enuresis and management 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AST/ALT ratio and enzyme pattern most strongly suggest alcoholic liver disease?","Question",{"text":63,"@type":64},"An AST/ALT ratio greater than 2 is very common in alcoholic liver disease, along with elevated GGT and often elevated ferritin.","Answer",{"name":66,"@type":61,"acceptedAnswer":67},"How high are AST and ALT levels typically in alcoholic hepatitis?",{"text":68,"@type":64},"In alcoholic liver disease, AST and ALT are usually less than 300 IU/L and almost always less than 500 IU/L.",{"name":70,"@type":61,"acceptedAnswer":71},"For a child with primary nocturnal enuresis that worsens after starting kindergarten, what is the best next step?",{"text":72,"@type":64},"Management should focus on treating exacerbating factors and behavioral measures; in the provided options, the key next step corresponds to restricting fluids during the 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ValuesNotesCalculatorReverse ColorText Zoom  \nA45-year-old man comes to the emergency department with poor appetite and nausea for the last 3-4 weeks.He admits to drinking vodka dailyHe attempted to quit on several occasions over the last year but relapsed each time.Two years ago,he was admitted for seizures but has had nomedical follow-up since.The patient takes no medications and does not use any illicit drugs.He has had no recent sexual encounters.He hasno recent unintentional weight loss.His temperature is 37.2C(99 F),blood pressure is 120/70 mm Hg,and pulse is 102/min.His sclerae appearicteric.The liver is enlarged and mildly tender.The gallbladder is not palpable,and Murphy's sign is negative.The patient has no abdominaldistension,peripheral edema,spider angiomas,gynecomastia,or asterixis.Which of the following laboratory findings are most likely to bepresent?  \nAST=aspartate aminotransferase;ALT=alanine aminotransferase;GGT=gamma-glutamyltransferase.  \n\n|  | AST   | ALT   | GGT   | Ferritin   |\n| --- | --- | --- | --- | --- |\n| ○ A.   | 230   | 111   | ↑   | ↑   |\n| ○ B.   | 2,500   | 1,050   | 个   | ↑   |\n| ○ c.   | 2,640   | 2,355   | ↑   | ↑   |\n| O D.   | 266   | 105   | Normal   | Normal   |\n| O E.   | 32   | 55   | 个   | Normal   |\n\nSubmit  \nSettings  \n☆  \nA AA  \n卡  \n1 of 40  \n0.2  \n三×  \nMark  \n□□□□  \ntion Id:2911  \nSettings  \nPrevious  \nNext  \nExit Mode  \nTutorial  \nText Zoom  \nLab Values  \nNotes  \nCalculator  \nReverse Color  \n\n|  | Clinical features of alcoholic hepatitis   |  |  |\n| --- | --- | --- | --- |\n|  | Clinical presentation   | ·Jaundice,anorexia,fever  \u003Cbr>·Right upper quadrant &/or epigastric pain  \u003Cbr>·Abdominal distension due to ascites  \u003Cbr>·Proximal muscle weakness from muscle wasting if malnourished  \u003Cbr>·Possible hepatic encephalopathy   |  |\n|  | Laboratory &imaging studies   | ·Elevated AST&ALT,usually \u003C300 U/L  \u003Cbr>·AST/ALT ratio ≥2  \u003Cbr>·Elevated GGT,bilirubin &/or INR  \u003Cbr>·Leukocytosis,predominantly neutrophils  \u003Cbr>·Decreased albumin if malnourished  \u003Cbr>·Abdominal imaging may show fatty liver   |  |\n|  | ALT=alanine aminotransferase;AST =aspartate aminotransferase;GGT=gamma-glutamyltransferase.   |  |  |\n\nThis patient,who has an extensive history of alcohol use,most likely has alcoholic hepatitis witth jaundice,anorexia,and tender hepatomegaly.There is no evidence of ascites or cirrhosis (eg,spider angiomas,gynecomastia,asterixis).He has no weight loss or systemic symptoms tosuggest malignancy,and there are no signs of infection.  \nAlcoholic liver disease is generally characterized by modest elevations in aspartate aminotransferase(AST)and alanine aminotransferase(ALT),usually\u003C300 IU/L and almost always \u003C500 IU/L.A ratio of AST to ALT>2(thought to be due to hepatic deficiency of pyridoxal 5'-phosphate,anALT enzyme cofactor)is very common in alcoholic liver disease (>90%in one study).However,it is rarely seen with other forms of liver disease,in which ALT is typically higher than AST.This can be used as an important diagnostic marker.There is no correlation between the degree ofelevation and liver disease severity.  \nElevations in gamma-glutamyltransferase(GGT),an enzyme present in liver and other cells,and in ferritin,an acute phase reactant,would likelybe seen in alcoholic liver disease.Normal values of AST and ALT (Choice E)or of GGT and ferritin (Choice D)would be less likely.  \n(Choices B and C)If marked elevations(>25 times the upper limit)of AST and ALT are present,toxin-induced(eg,acetaminophen),ischemic,orviral hepatitis should be suspected.  \n# Educational objective:\n\nAlcoholic hepatitis is generally characterized by a ratio of aspartate aminotransferase(AST)to alanine aminotransferase(ALT)>2,elevatedgamma-glutamyltransferase,and elevated feritin.The absolute values of ASTand ALT are almost always \u003C500 IULin alcoholic liver disease.  \nA6-year-old boy is brought to the office by his mother due to","cbCainPGmCtlwRuF","https://ap.wps.com/l/cbCainPGmCtlwRuF","pdf",39056012,133,"English","# Alcoholic hepatitis\n## Clinical presentation\n## Laboratory and imaging studies\n## Diagnostic laboratory markers (AST/ALT, GGT, ferritin)\n# Nocturnal enuresis (bed-wetting)\n## Definition and pathogenesis\n## Risk factors and evaluation\n## Management","[{\"question\":\"What AST/ALT ratio and enzyme pattern most strongly suggest alcoholic liver disease?\",\"answer\":\"An AST/ALT ratio greater than 2 is very common in alcoholic liver disease, along with elevated GGT and often elevated ferritin.\"},{\"question\":\"How high are AST and ALT levels typically in alcoholic hepatitis?\",\"answer\":\"In alcoholic liver disease, AST and ALT are usually less than 300 IU/L and almost always less than 500 IU/L.\"},{\"question\":\"For a child with primary nocturnal enuresis that worsens after starting kindergarten, what is the best next step?\",\"answer\":\"Management should focus on treating exacerbating factors and behavioral measures; in the provided options, the key next step corresponds to restricting fluids during the day.\"}]","Alcoholic Hepatitis - Diagnostic Marker and Laboratory Findings | PDF",1791592864,335]