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A 13-year-old boy with declining cognitive performance

13 years old | Male

Vignette:

A 13-year-old boy with declining cognitive performance and tremor is found to have an elevatedALTof192iU/L.

Summary:

declining cognitive performance | tremor | elevated ALT

Dx:

Wilson’s disease

Ref:

ccu hepatology EMQ 6.2 page 176

Rank

Disease

Weight

1 Primary biliary cirrhosis 180.0
2 Graves Disease 156.0
3 Hepatic Encephalopathy 153.0
4 Acute Cholangitis 143.0
5 Hyperthyroidism 136.0
6 Wilson disease 134.0
7 Non-diabetic hypoglycemia 134.0
8 Eclampsia 133.0
9 Biliary cirrhosis 132.0
10 Common cutaneous drug reactions 126.0
11 Chronic Hepatitis 124.0
12 Parkinson disease 121.0
13 Primary sclerosing cholangitis 116.0
14 Gallstone pancreatitis 114.0
15 Acute intermittent porphyria 108.0
16 Acute Liver Failure 101.0
17 Fungal meningitis 100.0
18 Spontaneous bacterial peritonitis 99.0
19 Acute fatty liver of pregnancy 97.0
20 Klebsiella pneumoniae liver abscess 97.0
21 Preeclampsia 95.0
22 Alcoholic hepatitis 92.0
23 Autoimmune hepatitis 92.0
24 Liver Cirrhosis 91.0
25 Toxic thyroid adenoma 86.0
26 Graves ophthalmopathy 84.0
27 Hemolytic uremic syndrome 84.0
28 chronic acalculous cholecystitis 83.0
29 Hypothyroidism 82.0
30 Choledocholithiasis 81.0
31 Alcoholic Liver Disease 79.0
32 Alcoholic Fatty Liver 79.0
33 Toxic Megacolon 77.0
34 Systemic lupus erythematosus 75.0
35 Fibromyalgia 75.0
36 Alcoholic Liver Cirrhosis 73.0
37 Acute Hepatitis 72.0
38 Acute disseminated encephalomyelitis 72.0
39 Adrenocortical carcinoma 72.0
40 Brucellosis 72.0
41 Acetaminophen overdose 71.0
42 Acute atrial fibrillation 70.0
43 Infectious mononucleosis 69.0
44 Pheochromocytoma 68.0
45 Gallbladder Dyskinesia 65.0
46 Non-alcoholic Fatty Liver Disease 64.0
47 Acute bacterial meningitis in neonates 63.0
48 Malaria 62.0
49 Rocky Mountain spotted fever 62.0
50 Ovarian Hyperstimulation Syndrome 60.0
51 Acute heart failure 59.0
52 Pyogenic Liver Abscess 59.0
53 Familial Mediterranean fever 57.0
54 biliary SOD 55.0
55 Alzheimer disease 54.0
56 Hepatocellular carcinoma 53.0
57 Pseudohypoparathyroidism 53.0
58 Hypercalcemia 50.0
59 Multiple Sclerosis 50.0
60 Anaphylaxis 50.0
61 Acute respiratory failure 50.0
62 Short bowel syndrome 50.0
63 Aseptic meningitis 50.0
64 Parkinsonism 50.0
65 Breast Cancer 50.0
66 Subdural hematoma 49.0
67 Chronic liver disease 48.0
68 Extraintestinal Entamoeba histolytica amebiasis 48.0
69 Bacterial gastroenteritis 46.0
70 Listerial gastroenteritis 46.0
71 Chronic bacterial prostatitis 46.0
72 Painless thyroiditis 46.0
73 Osteoarthritis 45.0
74 Tuberculous Peritonitis 44.0
75 Toxic multinodular goiter 44.0
76 Cholangiocarcinoma 43.0
77 Renal and perinephric abscess 43.0
78 COVID19 41.0
79 Autoimmune Pancreatitis 41.0
80 Acute peritonitis 40.0
81 Hyperparathyroidism 40.0
82 Primary Myelofibrosis 40.0
83 Hyperaldosteronism 40.0
84 Acute viral meningitis 40.0
85 Testicular cancer 40.0
86 Acute Lymphocytic Leukemia in Adults 39.0
87 Chronic Lymphocytic Leukemia 39.0
88 Cystic Fibrosis 39.0
89 Chronic Kidney Diseases 39.0
90 Essential Tremor 39.0
91 Kawasaki disease 38.0
92 Osteoporosis 38.0
93 Chronic atrial fibrillation 38.0
94 Acalculous Cholecystitis 38.0
95 Type 2 Diabetes mellitus 36.0
96 Pulmonary Embolism 36.0
97 Chronic Mitral regurgitation 36.0
98 Mirizzi Syndrome 36.0
99 Influenza 35.0
100 Hereditary hemochromatosis 35.0
101 Multiple endocrine neoplasia 2A 35.0
102 Gestational diabetes mellitus 35.0
103 Hypoparathyroidism 34.0
104 Typhoid infection 34.0
105 Candidal intertrigo 34.0
106 Candida Balanitis 34.0
107 Oropharyngeal and esophageal candidiasis 34.0
108 Vulvovaginal candidiasis 34.0
109 Oral candidiasis 34.0
110 Acute pyelonephritis in adults 34.0
111 Insect bites and stings 33.0
112 Goiter 32.0
113 Diffuse nontoxic goiter 32.0
114 Obstructive cervical goiters 32.0
115 Cervical goiter 32.0
116 Acute bacterial meningitis in adults 32.0
117 Colorectal cancer 32.0
118 Systemic sclerosis 31.0
119 Foreign body ingestion 31.0
120 Balanitis 31.0
121 Ileus 30.0
122 Hyperglycemia 30.0
123 Type 1 Diabetes mellitus 30.0
124 Renal vein thrombosis 30.0
125 Chronic Renal vein thrombosis 30.0
126 Acute Renal vein thrombosis 30.0
127 Gout 30.0
128 Celiac Disease 30.0
129 Sarcoidosis 30.0
130 Chronic Pancreatitis 30.0
131 Autoimmune hemolytic anemia 30.0
132 End Stage Renal Disease 30.0
133 Pharyngitis 30.0
134 STI HIV Pharyngitis 30.0
135 Herpes pharyngitis 30.0
136 Cholestasis 30.0
137 Intrahepatic Cholestasis 30.0
138 Food poisoning 30.0
139 Chronic fatigue syndrome 28.0
140 Campylobacter infection 28.0
141 Diabetic Kidney Disease 28.0
142 Diabetic Ketoacidosis 27.0
143 Hiatus hernia 27.0
144 cholestatic liver disease 27.0
145 Viral pharyngitis 27.0
146 Hyperprolactinemia 27.0
147 Liver disease 26.0
148 Gastric Outlet Obstruction 26.0
149 Non-small cell lung cancer 26.0
150 Chronic Clonorchiasis 26.0
151 Mitral Stenosis 26.0
152 Acute peptic ulcer 25.0
153 Gastroenteritis 25.0
154 Eosinophilic gastroenteritis 25.0
155 mucosal Eosinophilic gastroenteritis 25.0
156 Muscle Layer Eosinophilic gastroenteritis 25.0
157 subserosal eosinophilic gastroenteritis 25.0
158 Anaplastic thyroid cancer 25.0
159 Acute Myeloid Leukemia in children 25.0
160 Ovarian Cancer 25.0
161 chronic biliary obstruction 25.0
162 Bacterial pharyngitis 24.0
163 Optic neuritis 24.0
164 Neuropapillitis 24.0
165 Shigellosis 24.0
166 Autosomal Recessive Polycystic Kidney Disease 24.0
167 Ulcerative Colitis 23.0
168 Polyarteritis nodosa 23.0
169 Dystonia 23.0
170 Guillain-Barre syndrome 22.0
171 Gallstones 22.0
172 Budd Chiari Syndrome 21.0
173 Churg-Strauss Syndrome 21.0
174 Gallbladder cancer 21.0
175 Viral Gastroenteritis 20.0
176 Irritable Bowel Syndrome 20.0
177 Migraine 20.0
178 Paraphimosis 20.0
179 Obstructive Sleep Apnea 20.0
180 Pneumonia 20.0
181 Rheumatoid Arthritis 20.0
182 Immune thrombocytopenia 20.0
183 Aortic coarctation 20.0
184 chronic cholestatic liver disease 20.0
185 Glomerulonephritis 20.0
186 Acute Mitral regurgitation 20.0
187 pancreatic SOD 20.0
188 Amebic Liver Abscess 20.0
189 Atypical pneumonia 20.0
190 Ascites 19.0
191 Intussusception 19.0
192 COPD Exacerbation 19.0
193 Foodborne E coli infection 19.0
194 pancreatic cancer 18.0
195 Bullous pemphigoid 18.0
196 Hyperosmolar Hyperglycemic state 18.0
197 Amebiasis 18.0
198 Ovarian Torsion 18.0
199 Amphetamine use disorder 18.0
200 Disseminated intravascular coagulation 18.0
201 Croup 18.0
202 Multiple endocrine neoplasia 2B 18.0
203 Chronic Cholecystitis 18.0
204 Intrahepatic cholestasis of pregnancy 18.0
205 Adrenal crisis 17.0
206 Hepatorenal Syndrome 17.0
207 Intestinal Entamoeba histolytica amebiasis 17.0
208 Esophagitis 17.0
209 Penis Carcinoma 16.0
210 Milk-alkali syndrome 16.0
211 Acute Milk-alkali syndrome 16.0
212 Chronic Milk-alkali syndrome 16.0
213 Multiple Myeloma 16.0
214 Cholera 16.0
215 Allergic rhinitis 16.0
216 Non-cholera Vibrio infections 16.0
217 Insomnia in adults 16.0
218 Diabetes Mellitus 16.0
219 Bladder Cancer 16.0
220 Lung Cancer 15.0
221 Herpes zoster 15.0
222 Acute bacterial meningitis in children 15.0
223 Acute Cholecystitis 15.0
224 Emphysematous cholecystitis 15.0
225 Peutz-Jeghers Syndrome 15.0
226 Psoas Abscess 15.0
227 Ruptured Tuboovarian abscess 14.0
228 Acute Pancreatitis 14.0
229 Acute otitis media 14.0
230 Common cold(children) 14.0
231 Chronic heart failure 14.0
232 Cushing syndrome 14.0
233 Stroke 14.0
234 Central hypothyroidism 14.0
235 Nephrogenic diabetes insipidus 14.0
236 Central diabetes insipidus 14.0
237 Cryptococcosis 14.0
238 Peroneal Neuropathy 14.0
239 Stable angina 14.0
240 Extrahepatic Cholestasis 14.0
241 biliary obstruction 14.0
242 Menopause 13.0
243 Premenstrual syndrome 13.0
244 Addison Disease 12.0
245 Lactose intolerance 12.0
246 Common cold(adults) 12.0
247 Acute bacterial rhinosinusitis 12.0
248 Phenylketonuria 12.0
249 Clonorchiasis 12.0
250 Asthma 11.0
251 Atopic dermatitis 11.0
252 Crohn Disease 10.0
253 Thyroid lymphoma 10.0
254 Chronic Myeloid Leukemia 10.0
255 Systemic vasculitis 10.0
256 Gastritis 10.0
257 Inguinal hernia 9.0
258 Sunburn 9.0
259 Hereditary Angioedema 8.0
260 Drowning 8.0
261 Acute Lymphoblastic leukemia in children 8.0
262 Amyloidosis 8.0
263 Familial adenomatous polyposis syndrome 8.0
264 Paraneoplastic Syndromes 7.0
265 Aortic Dissection 7.0
266 Hemorrhagic stroke 7.0
267 Ischemic stroke 7.0
268 Gastroesophageal reflux disease 7.0
269 Periorbital and orbital cellulitis 7.0
270 Hemorrhoids 6.0
271 Thrombotic thrombocytopenic purpura 6.0
272 Psychogenic polydipsia 6.0
273 Endometriosis 6.0
274 Carpal Tunnel Syndrome 6.0
275 Anthrax 6.0
276 Leiomyomas 5.0
277 Renal Cell Carcinoma 5.0
278 Bed bugs 5.0
279 Ankylosing spondylitis 4.0
280 Migraine headache in adults 4.0
281 Hypogammaglobulinemia 4.0
282 Inflammatory Bowel Diseases 3.0
283 Alopecia areata 3.0
284 Chlamydia pneumoniae infection 2.0
285 Granulomatosis with polyangiitis 2.0
286 Acute Clonorchiasis 0.0
287 Bruxism 0.0
288 Myasthenia Gravis 0.0
289 Neonatal Myasthenia Gravis 0.0
290 Congenital Myasthenic Syndromes 0.0
291 Tetanus 0.0
292 Bell palsy 0.0
293 Stevens-Johnson syndrome 0.0