Perhaps
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A 47yo female comes to the ER because of severe abdominal pain for 3 hours. The pain began after a 2-week drinking binge. She has a 15-year history of alcoholism. She has no history of jaundice or hepatitis. Current medications include multivitamins and iron. Her temperature is 38°C (100.4°F), blood pressure is 110/80 mm Hg, and pulse is 110/min. Examination shows mild jaundice and diffuse spider angiomata over the trunk and abdomen. The liver is tender to palpation. A complete blood count shows mild anemia with normal red cell indices. Ultrasonography of the abdomen shows normal-sized hepatic ducts. Which of the following is the most likely set of laboratory findings?
Total Indirect Alkaline Alanine
Bilirubin Bilirubin Phosphatase Aminotransferase Reticulocyte
(mg/dL) (mg/dL) (U/L) (ALT, GPT) (U/L) Count (%)
A)2 0.9 80 30 1.2
B)3 2.8 70 30 1.0
C)3 2.8 80 20 3.0
D)4 2.0 800 200 1.5
E)4 1.0 150 400 1.0
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| Perhaps
Forum Elite
Topics: 61
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I picked D when answering the q thinking there is liver damage.
But after discussion, I am leaning towards B.
Not sure...
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| MAZI
Forum Elite
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B IS CORRECT
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| frank100
Forum Guru
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B
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| cbenitesch
Forum Senior
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B is correct. Without an obstructive pattern of AP we have A) B) andC) mild icterus TB choice B) or C) and mild anemia we expect reticulocytes go up, but index are OK.
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| abc888
Forum Newbie
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A
alcoholic hepatitis
must present markedly increased direct bilirubin.
B and C both have normal direct bilirubin (0.2)
"Although measurement of the conjugated fraction is not reliable in distinguishing biliary obstruction from parenchymal liver disease, the magnitude of bilirubin elevation may be prognostically useful in alcoholic hepatitis, PBC, and fulminant hepatic failure"
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| radonc
Forum Senior
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I am going to be a renegade and choose E.
This pt has alcoholic hepatitis. So, tranaminases must be elevated. ALP's are usually also elevated, yes even in hepatitis, not usually not more than 3x upper limit (which would indictae obstruction).
Bilirubin is up, both conjugated and unconjugated.
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| dr in trouble
Forum Guru
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Randoc in alcoholic hepatitis, AST shud be elevated, I will go with B but not sure.
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| radonc
Forum Senior
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Dr in trouble, I said what you said ...
If this is hepatitis secondary to alcohol, the AST should be elevated (at least more than 3x upper limit normal). In a pt who has a tender liver and mild jaundice, you would need AST >>> 30 U/L.
ALP is also elevated, but AST/ALT's are more markedly elevated than ALP in a 'hepatitic picture'.
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| radonc
Forum Senior
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My answer is still E.
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| dr19
Forum Senior
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D
in alcoholic hepatitis the ALT is almost never>300
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| Dr.D
Forum Senior
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E, direct bilirubin must be high because of obstructive pattern. alcoholic hepatitis
Reticulocyte count must be low
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| tamerbashir
Forum Elite
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we need now the true answer with explaination in details
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| tamerbashir
Forum Elite
Topics: 21
Posts: 285
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alcoholic hepatitis
must present markedly increased direct bilirubin
tranaminases must be elevated the ALT is almost never>300
ALP's are usually also elevated
Reticulocyte count must be low
so IAM WITH E
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| chemamr
Forum Hero
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kind of tricky question. maybe "F" is the answer.
anyways, I bet on E.
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| arlete
Attending in 2012!!!!!
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What's the answer, please?
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| Korotkoff
Forum Senior
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E is the answer.
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