Abnormal LFT

Question: Which of the following diseases that are known to cause a mild hepatitis can be diagnosed endoscopically via duodenal biopsy?

A. Chagas disease

B. hepatitis C virus

C. hemochromatosis

D. celiac sprue

Answer:  It’s important to know the lesser known causes of hepatitis.  We always think about viral and autoimmune causes, but what about things like hyperthyroidism, sarcoidosis or celiac sprue?  Sure, celiac sprue can present in all kinds of ways including osteopenia, anemia, depression and (mild) hepatitis; duodenal biopsy should show flattened villi.  That’s the correct answer.

Chagas disease can cause hepatomegaly (presumably from heart failure) and perhaps elevated LFT, but small bowel biopsy probably won’t yield a diagnosis.  EGD can be helpful in making a diagnosis of Chagas, however, but only when the classic, dilated esophagus is present.

Hereditary hemochromatosis certainly causes hepatitis, and is a first line test in the Caucasian demographic.  It even involves the small intestine, where a paucity of the hormone hepcidin allows the gut to release too much iron into the bloodstream.  However, duodenal biopsy is not an appropriate method of making a diagnosis of hemochromatosis.  Lastly, hepatitis C.  Just get a HCV RNA; duodenal biopsy obviously won’t help you confirm this diagnosis.

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