Favorite Quotes
"For every complex problem, there is a solution that is simple, neat, and wrong." - HL Mencken
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"I hear and I forget. I see and I remember. I do and I understand." - Confucius
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"The good physician treats the disease; the great physician treats the patient who has the disease" - Sir William Osler
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" The best test of a person's character is how he or she treats those with less power." - Bob Sutton
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"Those are my principles, and if you don't like them - well, I have others." - Groucho Marx
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"The difference between genius and stupidity is that genius has its limits." - Albert Einstein
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"It is hard enough to remember my opinions, without also remembering my reasons for them" - Friedrich Nietzsche
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"Anyone can make the simple complicated. Creativity is making the complicated simple." - Charles Mingus
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"Not everything that can be counted counts, and not everything that counts can be counted." - Albert Einstein
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"A foolish consistency is the hobgoblin of little minds, adored by little statesman and philosophers and divines. With consistency a great soul has simply nothing to do." - Ralph Waldo Emerson
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"This ain't no party, this ain't no disco, this ain't no fooling around." - Talking Heads, Life During Wartime
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"What is hateful to you, do not do to your neighbour. This is the whole Torah; all the rest is commentary. Go and learn it." - Hillel, Talmud, Shabbath 31a
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"You will never understand bureaucracies until you understand that for bureaucrats procedure is everything and outcomes are nothing." - Thomas Sowell
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"An idealist is one who, on noticing that a rose smells better than a cabbage, concludes that it will also make better soup." - HL Mencken
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"If you only have a hammer, you tend to see every problem as a nail." - Abraham Maslow
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"A great teacher is one who realizes that he himself is also a student and whose goal is not to dictate the answers, but to stimulate his students creativity enough so that they go out and find the answers themselves." - Herbie Hancock
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"There are no facts, only interpretations." - Nietzsche
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"An education isn't how much you have committed to memory, or even how much you know. It's being able to differentiate between what you do know and what you don't." - Anatole France
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"In character, in manner, in style, in all things, the supreme excellence is simplicity." - Henry Wadsworth Longfellow ====
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Archive for the ‘Liver tests’ Category
In which I reveal what caused the pancreatitis
18, Aug 2009MRCP suggested cholecystitis. We consulted surgery – laporoscopic cholectystectomy the next day with confirmation of cholecystitis.
The big clue is the ALT > 150. While not highly sensitive, this is highly specific for gallstone pancreatitis. My 3rd year student found the reference to that clue. I had always thought that the alk [...]
What caused the pancreatitis?
17, Aug 2009The patient is a 68-year-old man who presented with abdominal pain, nausea and vomiting. He described his pain as 10/10 sharp and mid-epigastric without radiation. He denied any lower gastrointestinal symptoms. Around 2 months previously he had a bout of pancreatitis, but his physicians did not find an etiology.
He had type II [...]
Why the man was jaundiced
29, Jan 2009
Here are the labs and question again:
Liver tests
Destruction
Obstruction
Factory
AST
966
alk phos
188
albumin
3.9
ALT
1784
T. Bili.
7.5
INR
1.1
Direct bilirubin – 5.8
Your job:
construct a differential diagnosis and make your best guess for the correct answer. We do know the answer.
=========
I will write this answer at the 3rd year medical student level, with apologies to anyone who thinks I have become pedantic. I do know that many students [...]
- In: Liver tests
A jaundiced man
27, Jan 2009
Here is a puzzle for you to consider. One of my residents told me that I needed to post more clnical problems.
Patient is 28-year-old white male with new jaundice. His only significant medical history is a 6-month history of grand mal seizures with a normal head CT.
He has noticed pale stools and dark urine for [...]
- In: Liver tests
The woman with RUQ pain – answered
23, Jun 2008
45 year old woman presents with RUQ pain, fatigue and loss of appetite
Liver tests
Destruction
Obstruction
Factory
AST
106
alk phos
250
albumin
1.9
ALT
35
T. Bili.
22.4
INR
1.6
Total protein 4.2
GGT 308
RUQ ultrasound showed gallbladder "sludge."
Questions:
1. Likely diagnosis
As several readers surmised, these labs represent a classic presentation of alcoholic hepatitis. The patient admitted to significant alcohol consumption.
She also had classic deficiencies – K, Phos, and Mg. She had [...]
- In: Liver tests
RUQ pain and abnormal labs
20, Jun 200845 year old woman presents with RUQ pain, fatigue and loss of appetite
Liver tests
Destruction
Obstruction
Factory
AST
106
alk phos
250
albumin
1.9
ALT
35
T. Bili.
22.4
INR
1.6
Total protein 4.2
GGT 308
RUQ ultrasound showed gallbladder "sludge."
Questions:
1. Likely diagnosis
2. Treatment options
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- In: Liver tests
Answer to 30 year old jaundiced man
24, May 2008
His liver tests show classic hepatocellular injury. His normal alkaline phosphatase argues strongly against extrahepatic obstruction. His normal albumin and INR argue against cirrhosis.
He could have any etiology of acute hepatocellular injury – toxins, shock or viral hepatitis. The loss of taste for cigarettes is a classic finding in viral hepatitis. He had acute hepatitis [...]
- In: Liver tests| Medical Rants
A jaundiced 30 year old man
23, May 2008
A 30 year old male phlebotomist presents with fatigue, anorexic and lost taste for cigarettes.
Liver tests
Destruction
Obstruction
Factory
AST
1750
alk phos
110
albumin
3.8
ALT
2050
T. Bili.
9.7
INR
1.0
Provide a differential diagnosis and speculate on the most likely diagnosis.
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- In: Liver tests
The liver puzzle answered
22, May 2008
I must congratulate the 2 responders, obviously astute diagnosticians. As they surmised, the liver tests did not support primary liver disease. The albumin was low but not what we would expect with cirrhosis. The other liver tests were remarkably normal.
We obtained an echocardiogram which showed severe pulmonary hypertension and pure right sided dilation and heart [...]
A liver puzzle
20, May 200855 year old man admitted to our service for ascites and anasarca (massive scrotal and leg edema.) The patient had large volume paracentesis. The SAAG (serum ascites albumin gradient) was 1.8 – consistent with portal hypertension. He had no evidence for spontaneous bacterial peritonitis. His serum ammonia was normal.
Later that evening he becomes hypoxic and [...]
A liver case
30, Apr 2008
Please create a differential diagnosis for the following liver tests in an 80 year old woman:
Liver tests
Total protein
4.8
Albumin
2.2
Total Bili
6.5
Direct Bili
4.3
Indirect Bili
2.2
Alk Phos
973
AST
170
ALT
100
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An important interesting presentation
18, Jun 2007Lisa Sanders hits another home run – Full-Body Failure
It was early evening by the time Walerstein got to see the patient. She was young — the chart said 22, but the slender figure surrounded by life-support equipment appeared even younger. She looked tired and sick and very, very yellow — highlighter yellow. He introduced himself [...]
- In: Liver tests| Medical Rants