A dogmatic but true medical statement is that there are no trivial elevations of liver enzymes. In other words, every case of liver enzyme elevation needs to be explained. Causes of liver enzyme elevation can be sorted into disorders of cholestasis and disorders of hepatocellular (liver) injury. Cholestatic disorders, where bile is prevented from leaving the liver by a blockage of the common bile duct (gallstone in the duct, pancreatitis, or tumor), tend to cause elevations in alkaline phosphatase, bilirubin, and gamma-glutamyl transferase, or GGT. Hepatocellular injury (hepatitis) raises levels of alanine aminotransferase (ALT) and aspartate aminotransferase (AST). The most common causes of liver enzyme elevation are alcohol use and

For most of recorded human history, personal health information has been collected, maintained, and analyzed mostly by healthcare professionals within the scope of diagnosis and treatment. This has been codified in our laws, especially by the Health Insurance Portability and Accountability Act, better known as HIPAA. The law governs the use, storage, and sharing of health records and it applies only to healthcare providers, insurance plans, and the plans’ “business associates.” Unfortunately

Hepatitis C (HCV) is a viral infection of the liver. It appears in media ads often now that direct-to-consumer pharmaceutical advertising is allowed in the U.S. Seventy-five to 85 percent of those infected will go on to develop a chronic hepatitis C infection which can lead to cirrhosis and liver cancer, often necessitating a liver transplant. It often causes no symptoms until cirrhosis appears, so the CDC recommends HCV blood testing for individuals who meet at least one of the following

2018 was the 100th anniversary of the 1918 influenza pandemic, (when an epidemic is worldwide, it is called a pandemic). That pandemic is estimated to have killed 50 million people. There were other flu pandemics in 1957, 1968, and 2009, but thankfully they were not as deadly as 1918. The influenza epidemic of 2017-2018 was a bad one with illness and mortality rates approaching that of a pandemic. It lasted 19 weeks, and killed more people than any other epidemic since 2010, particularly

The human small bowel is about 20 to 25 feet long and about one inch in diameter. The taller a person is, the longer his/her small bowel will be. The small bowel consists of three sections. The first and shortest segment is the duodenum, which is about eight to 10 inches long. The top of the duodenum connects to the stomach. The common bile duct, which starts in the liver and passes by the gallbladder and through the pancreas, empties into the mid duodenum via the sphincter of Oddo. The common

We live in a world dominated by technology where we all spend increasing amounts of time on our cell phones and computers, and less time observing the world around us. As I wrote a few months ago, this includes how medicine is practiced. Many physicians spend more time reviewing lab results and imaging studies than they do observing, listening to, and examining their patients, thereby dulling their senses.

When we think about the art of observation and deductive reasoning, we are reminded of

The opioid crisis is a real and growing concern in the U.S. As the only legal and regulated source of opioid prescriptions, physicians are increasingly under the regulatory agencies’ microscope and many physicians, including me, are reluctant to prescribe them at all. The problem is, however, that there are many people with chronic pain disorders who rely on these drugs for pain relief. Today I would like to delve into the use of opioids for pain relief.

There is a distinction between chronic

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