achilles
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A 54-year-old, malnourished man is admitted for evaluation of jaundice, ascites, and tenderness in the right upper abdomen. His temperature is 38 C (100.4 F). Physical examination reveals mild hepatomegaly and splenomegaly, as well as generalized muscle wasting. Ultrasound examination confirms the presence of an enlarged liver and a small amount of ascitic fluid. Laboratory studies show:
Serum albumin...........................2.5 g/dL
Globulin.....................................3.8 g/dL
Bilirubin:
Total........................................3.5 mg/dL
Direct......................................1.7 mg/dL
AST.........................................300 U/L
ALT.........................................120 U/L
Amylase...................................100 U/L
Alkaline phosphatase................100 U/L
Hematologic hemoglobin...........10 g/dL
Mean corpuscular volume.........100 µm
Leukocyte count.......................4000/mm3
Segmented neutrophils..............66%
Bands......................................7%
Prothrombin time......................18 sec
Which of the following is the most likely diagnosis?
A. Acute pancreatitis
B. Alcoholic hepatitis
C. Cholecystitis
D. Duodenal peptic ulcer
E. Viral hepatitis
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| drk1980
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going for B
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| chemamr
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B
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| AAAAA
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B
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| AAAAA
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Alcoholic hepatitis
An AST/ALT ratio greater than 1 is almost universal in persons with alcoholic hepatitis. Even in severe disease, the elevations of aminotransferase levels are modest, and an AST level greater than 500 U/L should raise suspicion of an alternative diagnosis. An AST/ALT ratio greater than 1 may accompany cirrhosis of any cause and, therefore, is less diagnostically specific in the setting of cirrhosis.
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| AAAAA
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1. AST/ALT > 1
2. AST <500
alcoholic hepatitis
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| AAAAA
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This patietn may be at high risk of hepatocellular carcinoma if he is a chronic carrier of hepatitis B S Ag, and develops cirrhosis.
Would you do a needle biopsy ??
CT/MRI has three echogenic mass in the liver.
I was faced with this problem now ?
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| achilles
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thats right. the ans is B-alcoholic hepatitis
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| MAZI
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dear AAAAA
in this case the onset is acute with tenderness & fever but in cancer i,m wating for chronic onset, I think
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