Case 4: Answer 4 questions on the Bottom please G.O. is a 50-year-old white man
ID: 887545 • Letter: C
Question
Case 4: Answer 4 questions on the Bottom please
G.O. is a 50-year-old white man referred for help in managing his diabetes. Two years before his visit, diabetes was diagnosed during a routine exam. He was started on oral hypoglycemic agents. He initially responded to this treatment, but over the ensuing 2 years, his medication doses were slowly raised. At the time of referral, his fasting blood glucose levels were in the range of 150 mg/dl and his hemoglobin A1c (A1C) was 8%. He requested a consultation when he was advised to start on insulin therapy.
His medical history was significant for heavy alcohol intake and hepatitis B with full recovery. Family history was negative for diabetes and hemochromatosis. Physical exam revealed normal vital signs and no retinopathy or other signs of diabetic complications. His hand joints showed mild swelling and tenderness over the proximal interphalangeal joints, and his skin was slightly, diffusely hyperpigmented.
Lab data included:
Hematology Reference Ranges
Urinalysis Reference Ranges
Hgb
Specific Gravity
Hct
pH
WBC
Protein
Bands
Glucose
253
Segmented
Ketones
Lymphocytes
Bilirubin
Monocytes
Urobilinogen
Blood
Hgb A1C
7.9%
Nitrite
Hepatitis Screen
Negative
Leukocytes
Microscopic
Chemistry
Glucose
Cholesterol
BUN
Triglycerides
Creatinine
1.1
Bilirubin
0.8
Sodium
140
AST
66
<40 IU/L
Potassium
4.2
ALT
133
<40 IU/L
Chloride
100
ALP
30
Total C02
Total Protein
HCO3
22
Albumin
Iron
306
TIBC
315
% Saturation
97%
Ferritin
2920
Referral to a liver specialist resulted in a liver biopsy, which identified increased iron stores and early periportal fibrosis.
1.What is the probable diagnosis of this patient?
2.Why are the liver enzymes increased in this patient?
3.What is a general overview of the pathology caused by this disease?
4.What is the prevalence of this disease in the general and diabetic population?
Hematology Reference Ranges
Urinalysis Reference Ranges
Hgb
Specific Gravity
Hct
pH
WBC
Protein
Bands
Glucose
253
Segmented
Ketones
Lymphocytes
Bilirubin
Monocytes
Urobilinogen
Blood
Hgb A1C
7.9%
Nitrite
Hepatitis Screen
Negative
Leukocytes
Microscopic
Chemistry
Glucose
Cholesterol
BUN
Triglycerides
Creatinine
1.1
Bilirubin
0.8
Sodium
140
AST
66
<40 IU/L
Potassium
4.2
ALT
133
<40 IU/L
Chloride
100
ALP
30
Total C02
Total Protein
HCO3
22
Albumin
Iron
306
TIBC
315
% Saturation
97%
Ferritin
2920
Explanation / Answer
1. The diagnosis of this patient is increased level of iron stores which is identified by an increase in hepatic iron level. The abnormal function of liver.
2. The levels of the liver enzymes Alanine aminotransferase (ALT) and aspartat aminotransferase (AST) increases.
3.
4. The prevalence of this desease in general population is 0.3% and in diabetic population it is 1.5-2%.
Related Questions
drjack9650@gmail.com
Navigate
Integrity-first tutoring: explanations and feedback only — we do not complete graded work. Learn more.