Case Four A 55 year old man visited his physician because he noticed abdominal s
ID: 124300 • Letter: C
Question
Case Four
A 55 year old man visited his physician because he noticed abdominal swelling and complained of fatigue and weakness. Upon physical examination, the physician noted icteric sclera, some edema around the ankles, splenomegaly, and hepatomegaly. The patient also admitted to drinking at least 5 martinis every night and more on weekends for a number of years. The results of the hepatic function profile revealed:
Patient
Reference Range
Total Protein
7.2
6.4-8.3 g/dL
Albumin
3.0
3.5-5.2 g/dL
Total bilirubin
2.5
0-2.0 mg/dL
Direct bilirubin
1.5
0.0-0.2 mg/dL
ALP
214
56-119 U/L
AST
350
<35 U/L
ALT
200
<45 U/L
Additional results revealed:
Patient
Reference Range
GGT
300
<55 U/L
Cholesterol
160
<200 mg/dL
Further tests revealed:
Patient
Reference Range
Anti- HCV
Nonreactive
Nonreactive
Anti- HAV (IgM)
Nonreactive
Nonreactive
Anti- HAV (Total)
Nonreactive
Nonreactive
Anti- HBsAg
Nonreactive
Nonreactive
Anti- HBcAg
Nonreactive
Nonreactive
1. What is the significance of abdominal swelling?
2. Is a low albumin result consistent with the results for the other liver function tests?
3. What is the significance of the negative (non reactive) serology tests?
Patient
Reference Range
Total Protein
7.2
6.4-8.3 g/dL
Albumin
3.0
3.5-5.2 g/dL
Total bilirubin
2.5
0-2.0 mg/dL
Direct bilirubin
1.5
0.0-0.2 mg/dL
ALP
214
56-119 U/L
AST
350
<35 U/L
ALT
200
<45 U/L
Explanation / Answer
1.Abdominal swelling also called abdominal distension in medical terms is presented in cases of gases, autoimmune disease and enlargement of certain abdominal organs to name a few. In the following case study the abdominal swelling is a clear sign of heptatomegaly (swelling in the left and right upper quadrant) as well as spleenomegaly (swelling in left upper quadrant). Thus through inspection of the physical status of the patient the healthcare worker was able to reach the above findings. That is the significance of abdominal swelling.
2. Yes, the low albumin level is consistent with the results for other liver function tests. This is because the inflammation of liver clearly indicates damage to the same in the above case study. This damage leads to decrease in the production of albumin as well as increase in the level of ALT and AST as noted in the following case. Thus the results are consistent with other liver function tests clearly hinting towards a case of possible liver cirrhosis.
3 . the non reactive serology test indicates absence of any infection and thus clears out biological cause of the liver damage.
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