Heme Derivatives Case Studies Case Three A 42 year old woman was admitted to the
ID: 124299 • Letter: H
Question
Heme Derivatives Case Studies
Case Three
A 42 year old woman was admitted to the ER with complaints of nausea, vomiting, chills, fever, and severe right upper quadrant pain. She had experienced similar symptoms a few times in the past 6 months but the episodes had been much milder and had disappeared in 2-3 hours. The ER physician noticed that she was visibly jaundiced and ordered a hepatic function panel:
Patient
Reference Range
Total Protein
7.4
6.4-8.3 g/dL
Albumin
4.0
3.5-5.2 g/dL
Total bilirubin
15.5
0-2.0 mg/dL
Direct bilirubin
10.3
0.0-0.2 mg/dL
ALP
645
53-128 U/L
AST
100
<35 U/L
ALT
105
<45 U/L
Additional results revealed:
Patient
Reference Range
GGT
400
<55 U/L
Amylase
98
28-100 U/L
Cholesterol
330
<200 mg/dL
1. In this case, the patient was visibly jaundiced. Which lab results correlate with a jaundiced patient?
2. Symptoms in this case correlate with acute appendicitis, cholelithiasis, cholangitis, hepatitis, pancreatitis, and cholecystitis. Which conditions are associated with the 4 F's (female, forties, fat, fertile (estrogen promotes secretion of bile salts)?
3. What is the significance of a direct bilirubin of 10.3 mg/dL when the total bilirubin is 15.5 mg/dL?
Patient
Reference Range
Total Protein
7.4
6.4-8.3 g/dL
Albumin
4.0
3.5-5.2 g/dL
Total bilirubin
15.5
0-2.0 mg/dL
Direct bilirubin
10.3
0.0-0.2 mg/dL
ALP
645
53-128 U/L
AST
100
<35 U/L
ALT
105
<45 U/L
Explanation / Answer
1)In this case, the patient was visibly jaundiced. Which lab results correlate with a jaundiced patient?
Total bilirubin:15.5 and Direct bilirubin :10.3 and raised SGPT,and SGOT shows elevated liver enzymes which is suggestive of jaundice.
2)Symptoms in this case correlate with acute appendicitis, cholelithiasis, cholangitis, hepatitis, pancreatitis, and cholecystitis. Which conditions are associated with the 4 F's (female, forties, fat, fertile (estrogen promotes secretion of bile salts)?
The most commonly found disease associated with four F is cholelithiasis
Female: Gallbladder disease and gallstones are most common in women due to the high levels of estrogen.
Forty: Forty is an indicator of the premenopausal time for women, bringing on spikes of estrogen levels.
Fertile: Women who are pregnant have higher levels of hormones or estrogen,which increases the cholesterol in the gall bladder which reduces the contraction of gallbladder thus leading to gall stones
Fat: Being overweight or losing weight too quickly can lead to gallbladder disease. People who are overweight have more cholesterol in their bile, and most gallstones are deposits of cholesterol.
3) What is the significance of a direct bilirubin of 10.3 mg/dL when the total bilirubin is 15.5 mg/dL?
Direct Billirubin is conjugated billirubin or water soluble billirubin .Direct billirubin is raised in case of obstruction in the bile duct caused by gall stones (Cholelithiasis),or inflammation of bile duct (cholecystistis)
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