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- Title
Diagnostic Momentum in Acute Liver Injury: an Exercise in Clinical Reasoning.
- Authors
Thomas, Isaiah; Roberts, Andrea; Sharma, Shreyak; Penner, John; Taddei, Tamar
- Abstract
In this case, the patient's initial presentation did not activate an illness script for malignancy-related ascites for the evaluating clinicians given the historical data available (e.g., recent increase in acetaminophen use) and higher baseline probability of more common causes (e.g., acetaminophen toxicity). In this case, the discussant recognizes that, although the patient demonstrated elevated liver enzymes and an elevated INR in conjunction with increased acetaminophen ingestion, his presentation lacks core features of the illness script for acetaminophen toxicity, such as markedly elevated liver enzymes. The clinician can then compare the problem representation against illness scripts for diseases that may fall within their schema for the represented problem. i [9] I In this case, when the discussant crystallizes this patient's problem into its most distinctive features, the case activates an illness script for malignancy. Classically, AST is greater than ALT, usually in a ratio of 2:1, when liver injury is associated with alcohol.[2] For this patient, ALT is greater than AST, making alcohol-related injury less likely.
- Subjects
PLEURAL effusions; MEDICAL logic; LIVER injuries
- Publication
JGIM: Journal of General Internal Medicine, 2022, Vol 37, Issue 11, p2861
- ISSN
0884-8734
- Publication type
Article
- DOI
10.1007/s11606-022-07673-4