Comments on: A jaundiced man http://www.medrants.com/archives/4055 Internal medicine, American health care, and especially medical education Sat, 11 Feb 2012 15:15:48 +0000 hourly 1 http://wordpress.org/?v=3.3.1 By: Number Seven http://www.medrants.com/archives/4055/comment-page-1#comment-523786 Number Seven Wed, 28 Jan 2009 18:26:45 +0000 http://www.medrants.com/?p=4055#comment-523786 Has he been taking anything for the seizures? The values seem suggestive of biliary obstruction rather than than an infectious process or toxicity, but never hurts to ask. He could have been having a malignancy for the last six months that has been causing the seizures that just now caused a blockage. Has he been taking anything for the seizures? The values seem suggestive of biliary obstruction rather than than an infectious process or toxicity, but never hurts to ask. He could have been having a malignancy for the last six months that has been causing the seizures that just now caused a blockage.

]]> By: shadowfax http://www.medrants.com/archives/4055/comment-page-1#comment-523774 shadowfax Wed, 28 Jan 2009 06:58:06 +0000 http://www.medrants.com/?p=4055#comment-523774 Differential Diagnosis. Diff-er-en-ti-al Di-a-gno-sis. Hmm. Can't say I've heard of the term before. What is it? The boy be blocked. Get pictures, call GI or surgery, send upstairs. Next! If you want to be fancy, I might suggest that the malignancy blocking his CBD may have a brain met causing the seizures. But that's super speculative.... Differential Diagnosis. Diff-er-en-ti-al Di-a-gno-sis. Hmm. Can’t say I’ve heard of the term before. What is it?

The boy be blocked. Get pictures, call GI or surgery, send upstairs. Next!

If you want to be fancy, I might suggest that the malignancy blocking his CBD may have a brain met causing the seizures. But that’s super speculative….

]]> By: Mogi http://www.medrants.com/archives/4055/comment-page-1#comment-523771 Mogi Wed, 28 Jan 2009 03:54:19 +0000 http://www.medrants.com/?p=4055#comment-523771 The coincident onset of the seizures and exposure suggest an infectious etiology, such as an unusual presentation of HCV or HIV? The coincident onset of the seizures and exposure suggest an infectious etiology, such as an unusual presentation of HCV or HIV?

]]> By: alexa-blue http://www.medrants.com/archives/4055/comment-page-1#comment-523766 alexa-blue Wed, 28 Jan 2009 00:38:27 +0000 http://www.medrants.com/?p=4055#comment-523766 Pt's enzymes c/w icteric phase hepatitis (despite elevated dbili, overall picture is more suggestive of hepatocellular damage); with seizures makes me think about Wilson's disease. Blood exposure suggests the usual stuff. Dilantin a good thought, though you're still left trying to explain the new seizures. Can get a post-ictal fulminant hepatitis. I guess should also think about alcohol, though that wouldn't really explain chronic seizures, and ALT/AST pattern is wrong. Would get the usual hep stuff (infectious panels, tylenol), ceruloplasmin, dilantin level (if he's on it). Second line - autoimmune stuff, ferritin, HIV. Awaiting smarter people. Pt’s enzymes c/w icteric phase hepatitis (despite elevated dbili, overall picture is more suggestive of hepatocellular damage); with seizures makes me think about Wilson’s disease. Blood exposure suggests the usual stuff. Dilantin a good thought, though you’re still left trying to explain the new seizures. Can get a post-ictal fulminant hepatitis. I guess should also think about alcohol, though that wouldn’t really explain chronic seizures, and ALT/AST pattern is wrong. Would get the usual hep stuff (infectious panels, tylenol), ceruloplasmin, dilantin level (if he’s on it). Second line – autoimmune stuff, ferritin, HIV. Awaiting smarter people.

]]> By: Grant http://www.medrants.com/archives/4055/comment-page-1#comment-523762 Grant Tue, 27 Jan 2009 22:58:53 +0000 http://www.medrants.com/?p=4055#comment-523762 hep c? hep c?

]]> By: david http://www.medrants.com/archives/4055/comment-page-1#comment-523760 david Tue, 27 Jan 2009 20:18:51 +0000 http://www.medrants.com/?p=4055#comment-523760 dilantin induced hepatitis dilantin induced hepatitis

]]> By: John http://www.medrants.com/archives/4055/comment-page-1#comment-523758 John Tue, 27 Jan 2009 19:44:20 +0000 http://www.medrants.com/?p=4055#comment-523758 I'm going to guess gallstones. Abdominal CT or sonography to confirm. Please be kind to my guess by the way, I'm in my 3rd year of a 6 year med program and I have not taken laboratory diagnosis. I’m going to guess gallstones. Abdominal CT or sonography to confirm. Please be kind to my guess by the way, I’m in my 3rd year of a 6 year med program and I have not taken laboratory diagnosis.

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