Quelling the Swelling

A 66 year old male with a history of compensated alcohol-related cirrhosis presents with abdominal swelling and a ten pound weight gain but denies any other symptoms. His exam is notable for normal vital signs and abdominal distension, and labs show an increase in his MELD-Na from 11 to 17, primarily due to an increased bilirubin and INR. AST and ALT are 17 and 13, respectively. What is the most likely cause of his acute decompensation?

Brisk Hematochezia in Cirrhosis

61 year old male with alcohol-related cirrhosis presents with severe ascites. He had a therapeutic paracentesis with improvement in his ascites and underwent a surveillance EGD which showed large varices that were then banded. The following day, he developed tachycardia, hypotension, and hematochezia. A nasogastric tube was placed to suction without blood return.

What is the most likely etiology of the bleed?

Biliary Ductal Dilation: Just Another Case of Malignancy?

A 47-year-old male presents with painless jaundice.  He also reports decreased appetite and energy, along with diffuse itching, pale stools, and dark urine. He denies any weight loss or history of liver disease. His physical exam is notable for jaundice and his labs show cholestasis (total bilirubin 6.3, primarily conjugated, and alkaline phosphatase of 347) and elevated transaminases (AST 160 and ALT 547). A MRCP shows intra-hepatic biliary dilation and retroperitoneal fibrosis without a mass or filling defect

What is the most likely underlying diagnosis?

Dyspnea After Liver Transplant: What’s Taking His Breath Away?

A 66-year-old male with a past medical history of primary biliary cholangitis s/p orthotopic liver transplant 10 months ago, ESRD s/p kidney transplant 2 months ago, presents with shortness of breath and dyspnea on exertion. His symptoms have gradually worsened over 2 weeks, and he is now short of breath walking across a room. He denies fevers, chills, and sick contacts. He is compliant with his medications and currently on prednisone, mycophenolate mofetil, and tacrolimus for immunosuppression. Liver chemistries are within normal limits and chest imaging shows a large right pleural effusion and right anterior chest wall mass. What is the most likely underlying diagnosis?

A Case of Psychosis and Elevated AST and ALT

A 22-year-old male with a past medical history of anxiety and depression presents with acute psychosis after ingesting 3.5 grams of marijuana. He takes vortioxetine at home. On presentation, he was found agitated, throwing himself against walls.  AST and ALT were 187 U/L and 44 U/L on admission. Five days later, AST and ALT increased to 1,402 U/L and 402 U/L. All other liver chemistry tests, hemoglobin, white blood cell count, and INR are normal. What is the most likely cause of his abnormal liver chemistry tests?