Download MBBS Case Studies Related to Jaundice and Liver Disorders Lecture PPT

Resmi, 18 years staying in a college hostel, brought in the

outpatient clinic of medical college complaining of fever, head

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ache, nausea and yellowish discoloration of sclera O/E: febrile,

Jaundice + liver palpable

Laboratory data:

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Total bilirubin- 6 mg% (0.3-1.2 mg/dl)
Conjugated bilirubin- 2.6 mg% (0.1-0.4 mg/dl)
ALP- 200 IU/L (40-125 IU/L)
ALT- 80 IU/L (10-35 IU/L)
AST- 70 IU/L ( 8-30 IU/L)

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Urinary Bile salts- +
Urinary Bile Pigment- +
Urinary Urobilinogen- Trace
What kind of illness, the girl is suffering from?
Evaluate the clinical condition by the laboratory data

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provided?

The girl is suffering from hepatic jaundice.
The clinical features fever, headache and nausea are

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suggestive of an infection and the finding of liver

enlargement with yellowish discoloration is suggestive

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of hepatic jaundice
Laboratory data confirms the hepatic origin of

jaundice

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Serum bilirubin levels
Elevated total bilirubin levels suggest jaundice
Hepatocyte dysfunction affecting glucoronyl

transferase activity caused elevation of unconjugated

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bilirubin (6-2.6=3.4 mg%)

The delayed clearance of CB due to blockage of biliary

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micro channels by inflammation leading to slight hike

in its level
Serum enzymes
Rise in transaminase shows injury to hepatocyte and its release

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from the cytoplasm of hepatocytes due to infection.

Slight elevation of ALP points towards the release of membrane

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bound ALP resulting from pressure effect produced by

inflammatory swelling of biliary lining cells caused by

infection.

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Urinary finding of positive bile salts and bile pigments again

indicate the patient is in the obstructive phase of hepatic

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jaundice i.e. infection causing inflammation of lining cells of

biliary canaliculi which results in regurgitation of biliary content

in to blood stream.

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When blood levels of these compounds crosses the renal thresh

hold for that substance, it gets excreted in urine- thus CB and

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bile salts are excreted in urine
Urobilinogen in trace amount suggests that there is no severe

obstruction as in biliary stone, strictures etc which cause

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complete obstruction of biliary flow in to intestine.

How to differentiate hepatic jaundice from obstructive

jaundice due to stones,tumors or other obstruction in biliary

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tract?

Serum bilirubin values
In obstructive jaundice the level of CB will be much higher than

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the hepatic jaundice and UCB values remain within normal

limits

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Enzymes
Transaminase values generally remain within normal range but

ALP values will be very high in obstructive jaundice
Urinary findings

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Bile salts + ve and CB + ve and urobilinogen will be

absent.

Due to biliary obstruction CB can not reach the

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intestine in obstructive jaundice and hence

urobilinogen can not be formed as in normal situation.

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Urine will be giving negative response to Ehrlich's test

and the patient will complain of passing clay coloured

stools due to absence of stercobilinogen in feces.

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Kurinji, 45 years old woman, a tribal hailing from waynaud district with severe

tiredness and severe pain all over the body O/E: Pallor+, Jaundice +,

Hepatosplenomegaly.

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Based on clinical and laboratory data what is your provisional diagnosis?
What other tests do you require to confirm diagnosis?

Laboratory data

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Hb- 7 g%
Sickling test- +ve
Total bilirubin- 10 mg%
CB- 0.6 mg%
UB- 9.4%

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ALP- 45 IU/L
ALT- 14 IU/L
AST- 20 IU/L
URINE

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Bile salts- Negative
Bile pigment-Negative
Urobilinogen- Strongly positive

The women is suffering from hemolytic jaundice probably due

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to sickle cell disease.

Total bilirubin and UCB are high- suggesting increase in bilirubin

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not due to any obstruction in the biliary passages.

Serum enzyme studies show normal activities indicating that

hepatocytes are not involved in disease process thereby

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excluding hepatic jaundice.

Absence of bile salts and bile pigment in urine show that

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jaundice is not due to any obstruction.
Increased urobilinogen is due to increase rate of RBC
break down producing maximum amount of

conjugated bilirubin getting secreted into intestine

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and converted to urobilinogen in increasing amounts

which is then absorbed from intestine in to blood and

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excreted in urine in excess amount.
The positive sickling test, tribal origin of the woman

and the kind of pain is suggestive of sickling crisis and

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strongly suggestive of sickle cell disease.
It is to be confirmed by Hb electrophoresis
Meenakshi,58 year old woman c/o pain in the upper

right side of the abdomen, fever with chills, pruritus ,

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passing dark color urine and clay colored stools. O/E:

Jaundice +, scratch marks on the skin +, fever+.

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From the following laboratory data explain what

would be provisional diagnosis?

Serum TB- 12 mg%

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CB- 10 mg%
ALP- 300 IU/L
ALT- 30 IU/L
AST- 18 IU/L
Urine

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Bile salts- +ve
Bile pigment- +ve
Urobilinogen- Negative

The lady is suffering from obstructive jaundice

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(cholestasis)

Total bilirubin and conjugated bilirubin is high ?

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suggesting of obstruction of biliary passages leading to

cholestasis.

Serum enzyme studies shows high ALP indicating

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obstructive type of jaundice and normal transaminases

giving an idea hepatocytes are unaffected by the disease

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process.
Urine- Test for Bile salts (Hay's test) +ve- supporting

the diagnosis of obstructive jaundice.

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Obstruction of biliary passages causing stasis of its

contents leading to regurgitation of its constituents

into blood and thereby elevating the concentration of

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CB and bile salts in to blood.

Bile salts has a tendency to get deposited in the skin

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causing intense pruritus and CB and Bile salts will be

excreted in urine