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 jaundiceLaboratory data confirms the hepatic origin of
jaundice
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Serum bilirubin levelsElevated 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 hikein 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 byinflammatory 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 ofbiliary 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 urineUrobilinogen 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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EnzymesTransaminase 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 beabsent.
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 testand 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 severetiredness 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/LALT- 14 IU/L
AST- 20 IU/L
URINE
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Bile salts- NegativeBile 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 whatwould 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- +veBile 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 tocholestasis.
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 itscontents 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 beexcreted in urine
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