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What is Moderate increase in serum aminotransferases with ASTiALT > 3 is suggestive of and explain in detail?
Ans. c (Alcoholic liver disease) (Ref: Harrison's Internal medicine 18th/Table 307-2)AST, ALTPredictors of alcoholic liver diseaseMild to moderate increaseMarked increaseAST> ALT= 2:1- suggestive.Fatty Liver pregnancyDrug-induced hepatitisAST > ALT = 3:1- Highly suggestive.Alcoholic liver diseaseCCFr GTP- Raised in all alcoholicsChronic hepatitisViral hepatitis (Acute)ALP- Moderate TPOOR PREDICTORS OF ALCOHOLIC HEPATITIS# PMN > 55,00/c mm# Discriminant score > 32# D.S = 4.6 X Prothrombin time control + Serum Bilirubin# Drug used for treatment: Prednisolone (DOC)-preferred choice; others-Pentoxiphylline, TNF a InhibitorsLaboratory Diagnosis of Alcoholic Fatty Liver and Alcoholic HepatitisTestCommentASTIncreased two- to sevenfold, <400 U/L, greater than ALTALTIncreased two- to sevenfold, <400 U/LAST/ALTUsually >1GGTP (maglutamyl transpeptidase)Not specific to alcohol, easily inducible, elevated in all forms of fatty liverBilirubinMay be markedly increased in alcoholic hepatitis despite modest elevation in alkaline phosphatasePolymorphonuclear cellsIf >5500/L, predicts severe alcoholic hepatitis when discriminant function >32