Liver tests

In which I reveal what caused the pancreatitis

August 18, 2009

MRCP 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 phos was the [...]

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What caused the pancreatitis?

August 17, 2009

The 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 diabetes mellitus, [...]

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Why the man was jaundiced

January 29, 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.  [...]

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A jaundiced man

January 27, 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 [...]

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The woman with RUQ pain – answered

June 23, 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 [...]

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RUQ pain and abnormal labs

June 20, 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 2. [...]

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Answer to 30 year old jaundiced man

May 24, 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 [...]

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A jaundiced 30 year old man

May 23, 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 [...]

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The liver puzzle answered

May 22, 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 [...]

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A liver puzzle

May 20, 2008

55 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 [...]

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