phuluong2k
Forum Fanatic
Topics: 714
Posts: 2,008
|
47) A 53-year-old woman presents complaining of fatigue over the past 6 months. During this time, she has also developed pruritus and lost 4 pounds. She is not sexually active, and her past medical history is significant only for Sj?n syndrome. On physical examination, she is afebrile and has mildly icteric sclera. There are excoriations noted on all four extremities and trunk and back. The liver edge is smooth and non-tender and measures 9 cm at the midclavicular line. There is no ascites, splenomegaly, or peripheral edema. Laboratory results reveal a normal complete blood count, normal electrolytes, and liver function tests with an alkaline phosphatase of 260 U/L (normal, <110 U/L), total bilirubin of 3.1 mg/dL, and normal transaminase levels. Which of the following is the most likely diagnosis?
A. Acute cholecystitis
B. Acute hepatitis A infection
C. Bacterial cholangitis
D. Primary biliary cirrhosis
E. Primary sclerosing cholangitis
|
| kabu
Forum Senior
Topics: 19
Posts: 105
|
D.
|
| ARJ
Forum Guru
Topics: 133
Posts: 792
|
D. Primary biliary cirrhosis
___________________
"Live as if you were to die tomorrow. Learn as if you were to live forever." --Mahatma Gandhi
|
| phuluong2k
Forum Fanatic
Topics: 714
Posts: 2,008
|
Right, how do you differentiate from E ?
|
| kabu
Forum Senior
Topics: 19
Posts: 105
|
sex, age, presentation and of course if they had mentioned anti mitochondrial ab that would have clinched it.
|
| nisha
Forum Guru
Topics: 146
Posts: 919
|
Primary scl cholangitis affects intra and extra hepatic bile ducts, associated with IBD in 70% cases, occurs in young males, diag of choice is ERCP, and beaded appearance on choangiography
Primary Biliary cirrhosis: autoimmune, middle aged woman, anti-mitochondrial antibody positive, only intrahepatic biliary ducts affected, diag usually on biopsy..
and that's all i know, feel free to add on:
___________________
IM resident
|
|
| |
| | | | | | |
