Advanced Endoscopy & Treatment Center

18/02/2026

17/02/2026

High LDH Diagnostic Pairing Guide
When LDH High, Look for the Partner

High LDH + High Uric Acid
Think Tumor Lysis Syndrome

High LDH + High CK
Think Muscle Injury / Rhabdomyolysis

High LDH + Very High AST/ALT
Think Hepatic Necrosis (Ischemic or Acute Hepatitis)

High LDH + High Indirect Bilirubin + Low Haptoglobin
Think Hemolysis

Very High LDH (>1000) + Anemia + Schistocytes
Think TTP / HUS (Microangiopathic Hemolytic Anemia)

Extremely High LDH (>2000–3000)

Think:
• Tumor lysis syndrome
• Severe hemolysis
• TTP
• Ischemic hepatitis
• Massive tissue necrosis

17/02/2026

Extrahepatic Manifestations of chronic Hepatitis C
• Mixed cryoglobulinemia
• MPGN
• Porphyria cutanea tarda
• Lichen planus
• B-cell lymphoma
• Insulin resistance

16/02/2026

16/02/2026

Recurrent Biliary Colic with Negative Ultrasound
What Should We Do?
In patients with typical biliary colic but no gallstones detected on initial transabdominal ultrasonography
small stones or sludge may have been missed.

Recommended Approach
Repeat the transabdominal ultrasound after a few weeks, especially if symptoms persist.

Key Areas That Must Be Carefully Examined on Repeat Ultrasound

Hartmann’s Pouch
Stones can lodge at the gallbladder outlet
A common site for missed small calculi

Gallbladder Neck
Must be traced carefully
Follow the neck all the way toward the porta hepatis
Exclude impacted stones in this region

Phrygian Cap
(If Present)
A fundal out-pouching or folding variant
The redundant portion of the fundus should be meticulously examined
Stones can hide within this fold

Clinical Pearl

A negative initial ultrasound does not exclude cholelithiasis in a patient with classic biliary colic.
Careful repeat scanning with focused evaluation of Hartmann’s pouch, gallbladder neck, and any Phrygian cap variant improves diagnostic yield.
If repeat ultrasound remains negative and symptoms are typical, consider:
Endoscopic ultrasound (EUS)
MRCP
Evaluation for biliary dyskinesia (HIDA scan with EF measurement)
If you would like, I can convert this into a clean infographic layout in English suitable for teaching or posting.

16/02/2026

Stomach Cancer: Don't Miss These Signs