Background: Inpatient subspecialty consultation is one of the most common physician practices in the care of hospitalized patients. As per a CMS report, approximately 33,000 inpatient consultation occurred per day in 2008 costing Medicare approximately $1.9 billion. Common reasons for requesting a consultation include assistance with treatment, diagnosis, and request for a procedure. Consult quality [...]

Background: Wilson Disease (WD) is a known cause of liver test abnormalities. Guidelines have been established to help clinicians avoid routine testing. According to the American Association for the Study of Liver Diseases (AASLD) Guideline, screening for WD—with serum ceruloplasmin, 24-hour urinary copper excretion, and slit-lamp examination for Kayser-Fleischer rings—is warranted in any patient with [...]

Case Presentation: A 56-year-old male with a history of 45 pack-year smoking, peptic ulcer, and cholecystectomy 5 months ago presented with worsening epigastric pain and 70-pound weight loss over the last 3 months, associated with subjective fevers, drenching night sweat, and malaise. The patient was hospitalized a month ago for the same reason, when computed [...]

Case Presentation: A fifteen-year-old previously healthy male presented with one and a half months of intermittent right upper quadrant pain with one month of decreased appetite and weight loss. He was followed by his primary care physician who initiated an outpatient workup approximately two weeks into his disease course. A CT scan of the abdomen [...]

Case Presentation: A 35-year-old healthy male veteran presented to the emergency room with painless jaundice. Three days prior to presentation, the patient noticed a yellowing of his eyes, but was otherwise asymptomatic. His history was notable for traumatic brain injury, PTSD, heterozygous gene mutation for hemochromatosis, and alcohol abuse with prior elevations in his aminotransferases [...]

Case Presentation: Budd Chiari is a rare disorder caused by hepatic venous outflow obstruction with resulting hepatic dysfunction. It affects 1.4 per million people a year, and presentation depends upon the extent and rapidity of hepatic vein occlusion. This case is noteworthy given it presents the rapid progression of liver dysfunction in the setting of newly [...]

Case Presentation: A 50-year-old woman presented with two weeks of progressively worsening abdominal pain and distention. The abdominal pain was accompanied by yellowing of her eyes and periods of confusion. She reported consuming 4 shots of vodka daily for greater than 10 years. Vital signs were normal. The patient was grossly jaundiced and exhibited scleral [...]

Case Presentation: Significant alcohol consumption can lead to a variety of alcoholic liver diseases ranging from alcoholic fatty liver disease to alcoholic hepatitis. Here, we discuss an atypical presentation of alcoholic hepatitis in a patient initially thought to have a hematologic malignancy. Our patient was a 28-year-old Cantonese-American man presenting with one month of fevers, [...]

Case Presentation: A 55 year-old Korean male with a past medical history of hypertension and hyperlipidemia presented to the Emergency Department after feeling short of breath with chest pain, palpitations, mottled skin and blue lips. He endorsed five days of fever, headache, shortness of breath, abdominal pain and nausea. He denied recent travel and sick [...]

Case Presentation: 63-year-old male with history of hypertension (HTN) on Lisinopril, with recent addition of hydrochlorothiazide (HCTZ) for uncontrolled HTN a week prior to presentation. He presented with dark color urine, nausea, constipation reported to have ensued a week after HCTZ was added to his regimen. He denied IV drug, alcohol, acetaminophen or any over [...]