A multi-panel figure illustrating diagnostic findings and clinical progression for a biliary obstruction and pancreatitis case. (A-C) Line graphs track liver function tests, showing a downward trend in total bilirubin (TBIL), gamma-glutamyl transpeptidase (γ-GT), alkaline phosphatase (ALP), alanine aminotransferase (ALT), and aspartate aminotransferase (AST) from initial presentation through biliary stent placement to admission. (D, E) Axial contrast-enhanced CT scans of the abdomen show a hyperdense biliary stent within the common bile duct, accompanied by a plump pancreatic parenchyma and peripancreatic fat stranding (cloudy adipose tissue) indicative of secondary pancreatitis. (F) Coronal Magnetic Resonance Cholangiopancreatography (MRCP) reveals the biliary anatomy and site of ductal stenosis. (G, H) PET-CT transaxial, PET, and fused images demonstrate the metabolic activity in the upper abdomen, used here to screen for malignancy. This composite clinical visual serves as an educational tool for integrating biochemical trends with multimodality imaging (CT, MRCP, PET-CT) in the workup of hepatobiliary diseases and pancreatic complications.

A multi-panel figure illustrating longitudinal blood markers and diagnostic imaging in a swine animal model of biliary stricture. Panels A-G consist of line graphs and data tables for two subjects (Pig 1 and Pig 2) across three time points: Pre-RFA (Radiofrequency Ablation), Post-RFA, and Pre-Harvesting. The measured markers include inflammatory indicators (WBC, CRP) and hepatobiliary liver function tests (Total Bilirubin, AST, ALT, ALP, and GGT). All markers consistently show a sharp elevation following the intraductal RFA procedure—indicating acute inflammation and cholestasis—followed by a decrease toward baseline at the 1-month follow-up (Pre-harvesting). C-reactive protein (CRP) displays the highest fold-change relative to baseline. Panels H and I are fluoroscopic cholangiography images obtained during Endoscopic Retrograde Cholangiopancreatography (ERCP). These images demonstrate biliary stenosis in the common bile duct, characterized by contrast narrowing and upstream proximal ductal dilatation. One subject shows a focal, high-grade obstruction, while the other exhibits a more gradual narrowing with a distinct pre-stenotic pouch-like dilatation.

This composite educational resource documents hepatic function trends and dermatologic manifestations following CAR-T cell therapy and subsequent hematopoietic stem cell (HSC) infusion, illustrating complications consistent with acute graft-versus-host disease (aGVHD). Panel A contains three line graphs tracking clinical biomarkers over a 120-day period. The first graph displays bilirubin levels, showing sharp elevations in Total Bilirubin (TBIL), Direct Bilirubin (DBIL), and Indirect Bilirubin (IBIL), with TBIL peaking near 180 µM. The second graph tracks transaminases (ALT and AST), showing an initial spike followed by a secondary, more severe elevation reaching over 300 U/L after day 90. The third graph monitors Total Protein (TP) and Albumin, exhibiting a general decline post-infusion. Panel B is a clinical photograph showing a severe skin rash. The image displays a large, irregular lesion characterized by central necrosis, ulceration, and dark eschar-like tissue. The surrounding skin exhibits diffuse erythema, hyperpigmentation, and numerous small petechial or papular spots. This visual evidence supports a diagnosis of high-grade aGVHD affecting both the liver and integumentary system.

Summary : This flowchart outlines the diagnostic workup for abnormal liver tests in pregnant women, distinguishing between hepatocellular and biliary profiles, and guiding further testing and management based on initial findings. flowchart: # Nodes : • Start: "Pregnant woman: initial workup of abnormal liver tests" (red rectangle) • Decision: "Hepatocellular profile? AST/ALT" (yellow rectangle) • Decision: "Biliary profile? elevated bili/alk phos" (green rectangle) • Process: "Rule out: Viral hepatitis, Herpes, Medications, Other**" (yellow rectangle) • Process: "Anti-HAV IgM, HBsAg, Hepatitis E IgM, HSV PCR" (yellow rectangle) • Process: "See Pregnancy-related workup" (purple rectangle) • Decision: "Bilirubin +/- alk phos" (green rectangle) • Decision: "Alk phos only" (green rectangle) • Process: "Biliary imaging" (green rectangle) • Process: "No further workup" (green rectangle) • Decision: "No evidence of obstruction" (green rectangle) • Process: "See Pregnancy-related workup" (purple rectangle) # Connectors : • The initial node splits into two branches: hepatocellular profile (left) and biliary profile (right). • Hepatocellular profile branch: – "Hepatocellular profile? AST/ALT" → "Rule out: Viral hepatitis, Herpes, Medications, Other**" – "Rule out: ..." → "Anti-HAV IgM, HBsAg, Hepatitis E IgM, HSV PCR" – "Anti-HAV IgM, ..." → "See Pregnancy-related workup" • Biliary profile branch: – "Biliary profile? elevated bili/alk phos" → two branches: • "Bilirubin +/- alk phos" → "Biliary imaging" → "No evidence of obstruction" → "See Pregnancy-related workup" • "Alk phos only" → "No further workup" # Layout : • The flowchart is organized as a top-down decision tree with two main branches (hepatocellular and biliary) diverging from the initial node. • The hepatocellular branch is on the left, the biliary branch is on the right. • The biliary branch further splits into two sub-branches based on the presence of bilirubin and/or alkaline phosphatase. # Analysis : • The flowchart provides a clear, stepwise approach for evaluating abnormal liver tests in pregnant women, emphasizing the importance of distinguishing between hepatocellular and biliary patterns. • It ensures that relevant infectious and non-infectious causes are considered and that unnecessary workup is avoided when only alkaline phosphatase is elevated. • The process directs clinicians to pregnancy-specific workup when indicated and highlights the need for biliary imaging if both bilirubin and alkaline phosphatase are elevated. • The chart also notes that other differential diagnoses (e.g., AIH, Wilson disease) should be considered if clinically appropriate.