milu
Forum Junior
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Posts: 35
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A patient visits the doctor complaining of chronic pain near the bottom of his ribcage. the docotr collects a urine sample and asks the patient to submit a stool specimen as soon as possible. the patient returns the next day with a stool specimen that is very pale in color.
PHYSICAL EXAMINATION
color - amber
Clarity - clear
CHEMICAL EXAMINATION
pH - 6.0
Specific gravity - 1.015
Protein - Trace
Glucose - neg
Keton - neg
Nitrite - neg
Blood - neg
Bilirubin - neg
Urobilinogen - moderate
Leukocyte - neg
MICROSCOPIC
Rbc - 0 to 2 per field
Wbc - 0 to 2
Bacteria - negative
Epithelial Cells - none
OTHER TESTS
SSA( sulfosalicylic acid test) - trace
QUESTION
1) which result are outside the normal range?
2) is it likely that the urobilinogen is actully normal?
3) what is the significance, if any, of the stool specimen?
help me with this case guys? ::very_confused::
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Mili
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| rubensssss
Forum Guru
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Color ambar anormal
Protein trace
Urobilinogen trace
SSA test trace (albumin and globulin)
Pain botton of ribcage
Stool pale in color
Just guessing...Which side is the pain it is on the back probable thinking Renal problem.
If pain on right side (Hypochondrial Rt) could I think on gallbladder problem.
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Ruben sssss
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| mani
Forum Guru
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i think u ve given findings of urine specimen not the stool. this seems to be a case of hepatitis as evidenced by:
chronic hypochondrial pain
increased urobilinogen in the urine
but the findings are not sufficient for the other diagnoses to be excluded. that needs furthur data like LFTs, and stool exam.
agreed??
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| rubensssss
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Thanks Mani you are right.
also the information given is incomplete,but do ing what we can.
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Ruben sssss
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| peekay
Forum Guru
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*ICAN'T EXPLAIN IN WORDS BUT IF U LOOK AT THE PIC IN FIRST AID FOR BILIRUBIN METABOLISM, U WILL SEE HOW OBSTRUCTION AT ONE AREA IS CAUSING METABOLITES TO INCREASE IN OTHER AREAS.
*IN THIS CASE UROBILINOGEN IS GOING TO URINE. WHICH TO MEE SEEMS LIKE A OBSTRUCTION AT REABSORPTION AT.
*CLAY COLORED STOOL IS DUE TO LESS CIRCULATION THROUGH G.I
*AMBER COLOR IS NOT NORMAL ( STRAY OR YELLOW COLOR IS)
AND ALOS BILIRUBIB SHOULD BE POSITIVE ( DIPSTICK TEST HAS INTRFERENCE BY COLOR) UNLESS BILIRUBIN IS CONFIRMED BY ICTO TEST .
**** PLEASE ADD MORE IF U KNOW MORE.
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| milu
Forum Junior
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thank you guys
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truth is great yet truthful living is the greatest....
Mili
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| Malaysian
Forum Guru
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Urobilinogen is normally seen in normal urine.Trace protein in urine can be normal too.To me all the figures appear normal.The only one I can doubt is the urine specific gravity.....whats the normal range,anyone?
Though clay stools are seen in obstructive jaundice,urobilinogen in urine is a characterictic of hemolytic jaundice and not of obstructive jaundice.From your above lab. data I can say the patient's clay stools are not attributable to obstructive jaundice and so must think of something else.Therefore I must say the diagnosis could be chronic pancreatitis instead.
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| Sakaki-
Forum Senior
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Posts: 238
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The normal range for specific gravity is 1.003 to 1.035, so it appears normal in this case. I did not think this was a case of obstructive jaundice (as the urinary urobilinogen should be decreased in such a case since less conjugated bilirubin enters the intestines in the first place). Rather, I agreed with the previous answer of hepatitis or some type of liver disease that is impairing the ability of the liver to conjugate the bilirubin. This would also account for the pale stools (due to the lack of bile pigments).
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