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 What about this man ?  



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Author10 Posts
  #1

A 30-year-old Italian man comes to the walk-in clinic with abdominal pain. He recently returned from a 2-week trip visiting his family in Sicily. Three days ago, he visited another clinic, where he was given trimethoprim-sulfamethoxazole for cystitis, a problem that he has not had before. His urinary tract symptoms have largely resolved, although his urine has darkened.

Recognizing the problem, the examining physician would most likely

A. Recommend a steroid dose pack for 5 days.

B. Check a urine culture.

C. Obtain an abdominal ultrasound study.

D. Check a blood count.

E. Order liver function tests.







  #2

E. Order liver function tests.

raised bilirubin???haemolytic anemia due to g6pd def.???

i dunno im jus guessingrin


  #3

seems E only raised eyebrow



  #4


Answer is D . Because the patient is from a Mediterranean country, he has a high likelihood of having G6PD deficiency. It is likely that he has experienced a hemolytic episode after sulfonamide exposure. He needs hydration and observation until the hemolysis resolves and his urine clears. There is no indication of inflammation for which a course of steroids (choice A) would be needed. A urine culture (choice B) is likely to show no growth because he is taking an antibiotic. An ultrasound study (choice C) is not indicated unless the problem persists. The “dark urine” is due to bilirubin from hemolysis; there is no reason to suspect abnormal liver function (choice E). Follow-up observation is important, however, to be certain that the problem resolves and to offer counseling about the problem.




  #5

oh ok.thanks smiling face how are u?



  #6

Just got up, feel sleepy, but my kiddo will put me into order very quickly ! It's like having a drill sergeant at home. grin



  #7

oh thats good,very goodmorning smiling face see you around.



Edited by keepgoing on Oct 02, 2008 - 4:02 AM

  #8

i jus wanna know CBC is only gonna give u "anemia"
LFTs is gonna give u raised bilirubin

why wud u choose blood count

is it cuz he can "check" the CBC and he has to "order" LFTs

thats only thing i can think of since none of the both answers are diagnostic for g6pd


  #9

iris786 wrote:
i jus wanna know CBC is only gonna give u "anemia"
LFTs is gonna give u raised bilirubin

why wud u choose blood count

is it cuz he can "check" the CBC and he has to "order" LFTs

thats only thing i can think of since none of the both answers are diagnostic for g6pd

Its true that CBC count is not definitive diagnostic criteria for G6PD Def but doing a CBC does make a lot of sense cos considering the Mediterranean descent and the his recent treatment with Sulfa Drugs, the most likely probability of disorder will lie in the blood rather than liver. As liver is only overloaded but not affected as its explained by darkening of his urine. (which gives another hint of raised indirect bilirubin.

Plus in the blood you would be able to see Heinz bodies which would indicate the presence of Hemolysis and also an indication of G6PD def.

Moi 2 cents



Edited by new_n_lost on Oct 04, 2008 - 3:59 AM

  #10

bloodjournal.hematologylibr.../cgi/content/full/111/1/16

Excellent Article for further knowledge






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