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Endoscopic Ultrasound-Guided Biliary Drainage: Endoscopic Ultrasound-Guided Hepaticogastrostomy in Malignant Biliary Obstruction
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Untangling the etiology of ascites
Michael Lopez-Molina1, Ashok V Shiani1, Kellee L Oller1
1Department of Internal Medicine, University of South Florida, Morsani College of Medicine, Tampa, FL, USA.
The American Journal of Case Reports
|April 7, 2015
Summary
Hepatic amyloidosis can present atypically, without the usual signs of cirrhosis or hepatomegaly. This case highlights the importance of considering rare causes of liver disease, even with unusual symptoms.
Area of Science:
- Hepatology
- Nephrology
- Cardiology
Background:
- Amyloidosis is a systemic disease affecting multiple organs, including the liver, heart, and kidneys.
- Hepatic amyloidosis typically does not present with cirrhosis, often showing hepatomegaly and mild lab abnormalities.
Observation:
- A 72-year-old male presented with anasarca, ascites, and hypotension, mimicking advanced liver disease.
- Initial liver function tests showed elevated bilirubin, AST, GGT, and alkaline phosphatase.
- Abdominal fluid analysis suggested portal hypertension, but the patient lacked typical stigmata of chronic liver disease and hepatosplenomegaly.
Findings:
- A liver biopsy revealed amyloid deposition, confirming hepatic amyloidosis.
- The patient's presentation was atypical, lacking the characteristic hepatomegaly often seen in hepatic amyloidosis.
Implications:
- This case underscores that liver disease can have ambiguous presentations, necessitating a broad differential diagnosis.
- Hepatic amyloidosis should be considered in patients with unexplained ascites and abnormal liver function tests, even without typical hepatomegaly.
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