Question of the Week

Question :
Posted On : 23 Jun 2012
6yr old male ,previously healthy, presented with abdominal distention that was ascitis by P, E and documented by U, S and ABDOMINAL CT scanthat reveal also irregular nodular small size liver no portal veiv thrombosis by doppler,WBC 7000,Hb 13 ,MCV 80,PLT 93, KFT NL, ALT 200,AST 370, ALP 1500 ,GGT 66, PT 21, 13 ,PTT 42, 33, protein 6, Alb 2.9, hepatitis profile negative,Ig ELECTROPHORESIS NL,ceruloplasmine 18 { 20-60 },ANA 1, 160,ASMA 1, 40 ,AMA NEGATIVE ,LKMA negative , thrombophilic screen NL ,EBV Igm negative, Alphafetoprt negative.
5
Expert Answer :
Patient has portal hypertension {ascites, low platelet count}, with elevated liver enzymes and irregular nodular liver most likely the cause is hepatic. Positive ANA and ASMA is suspicious for autoimmune hepatitis. He needs to undergo a liver biopsy for further evaluation. Also check serum copper, eye exam for KF ring, and alpha 1 antitrypsin phenotype.
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