Download MBBS (Bachelor of Medicine and Bachelor of Surgery) Latest 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
ache, nausea and yellowish discoloration of sclera O/E: febrile,
Jaundice + liver palpable
Laboratory data:
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)
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
provided?
The girl is suffering from hepatic jaundice.
The clinical features fever, headache and nausea are
suggestive of an infection and the finding of liver
enlargement with yellowish discoloration is suggestive
of hepatic jaundice
Laboratory data confirms the hepatic origin of
jaundice
Serum bilirubin levels
Elevated total bilirubin levels suggest jaundice
Hepatocyte dysfunction affecting glucoronyl
transferase activity caused elevation of unconjugated
bilirubin (6-2.6=3.4 mg%)
The delayed clearance of CB due to blockage of biliary
micro channels by inflammation leading to slight hike
in its level
Serum enzymes
Rise in transaminase shows injury to hepatocyte and its release
from the cytoplasm of hepatocytes due to infection.
Slight elevation of ALP points towards the release of membrane
bound ALP resulting from pressure effect produced by
inflammatory swelling of biliary lining cells caused by
infection.
Urinary finding of positive bile salts and bile pigments again
indicate the patient is in the obstructive phase of hepatic
jaundice i.e. infection causing inflammation of lining cells of
biliary canaliculi which results in regurgitation of biliary content
in to blood stream.
When blood levels of these compounds crosses the renal thresh
hold for that substance, it gets excreted in urine- thus CB and
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
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
tract?
Serum bilirubin values
In obstructive jaundice the level of CB will be much higher than
the hepatic jaundice and UCB values remain within normal
limits
Enzymes
Transaminase values generally remain within normal range but
ALP values will be very high in obstructive jaundice
Urinary findings
Bile salts + ve and CB + ve and urobilinogen will be
absent.
Due to biliary obstruction CB can not reach the
intestine in obstructive jaundice and hence
urobilinogen can not be formed as in normal situation.
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.
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.
Based on clinical and laboratory data what is your provisional diagnosis?
What other tests do you require to confirm diagnosis?
Laboratory data
Hb- 7 g%
Sickling test- +ve
Total bilirubin- 10 mg%
CB- 0.6 mg%
UB- 9.4%
ALP- 45 IU/L
ALT- 14 IU/L
AST- 20 IU/L
URINE
Bile salts- Negative
Bile pigment-Negative
Urobilinogen- Strongly positive
The women is suffering from hemolytic jaundice probably due
to sickle cell disease.
Total bilirubin and UCB are high- suggesting increase in bilirubin
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
excluding hepatic jaundice.
Absence of bile salts and bile pigment in urine show that
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
and converted to urobilinogen in increasing amounts
which is then absorbed from intestine in to blood and
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
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 ,
passing dark color urine and clay colored stools. O/E:
Jaundice +, scratch marks on the skin +, fever+.
From the following laboratory data explain what
would be provisional diagnosis?
Serum TB- 12 mg%
CB- 10 mg%
ALP- 300 IU/L
ALT- 30 IU/L
AST- 18 IU/L
Urine
Bile salts- +ve
Bile pigment- +ve
Urobilinogen- Negative
The lady is suffering from obstructive jaundice
(cholestasis)
Total bilirubin and conjugated bilirubin is high ?
suggesting of obstruction of biliary passages leading to
cholestasis.
Serum enzyme studies shows high ALP indicating
obstructive type of jaundice and normal transaminases
giving an idea hepatocytes are unaffected by the disease
process.
Urine- Test for Bile salts (Hay's test) +ve- supporting
the diagnosis of obstructive jaundice.
Obstruction of biliary passages causing stasis of its
contents leading to regurgitation of its constituents
into blood and thereby elevating the concentration of
CB and bile salts in to blood.
Bile salts has a tendency to get deposited in the skin
causing intense pruritus and CB and Bile salts will be
excreted in urine
This post was last modified on 30 November 2021