A 38-year-old man was admitted to hospital complaining ofweakness, pain in the joints, frequent headaches, nausea, fatigueand malaise. He stated he has been feeling this way for at least acouple of weeks. In addition, he has lost 12 pounds for no apparentreason and his urine has become darker in color. His family saidthat he has become increasingly irritable and forgetful.
The physical (PE) showed him to be alert and oriented, his skinand sclera were yellow, his abdomen tender and swollen, and bruiseswere found on his legs and hips.
A urinalysis was performed on admission. The results were asfollows:
|
URINALYSIS |
||
|
Test |
Results |
Units |
|
Color |
Amber |
|
|
Appearance |
Clear |
|
|
Sp. Gravity |
1.017 |
|
|
pH |
6.0 |
|
|
Protein |
Trace |
|
|
Glucose |
Negative |
mg/dL |
|
Blood |
Negative |
mg/dL |
|
Ketones |
Negative |
mg/dL |
|
Bilirubin |
2+ |
mg/dL |
|
Nitrite |
Negative |
mg/dL |
|
Leukocyte esterase |
Negative |
mg/dL |
|
Urobilinogen |
1.0 EU |
g/dL |
|
Microscopic |
0-1 WBC |
cells/hpf |
1) State which urinalysis data would be consideredclinically significant AND please explain why?
2) What type of bilirubin is causing the positive urinebilirubin result? Explain why only this form of bilirubin can befound in urine.
His respiratory, cardiac, and neurological systems were normal.He denied the use of drugs or alcohol or medications, other thanaspirin for headaches and the pain from his dental work about twomonths ago. He didn’t participate in contact sports.
Additional laboratory results were as follows:
|
HEMATOLOGY |
||
|
Test |
Results |
Units |
|
WBC |
x 103/ul |
|
|
RBC |
x 106/ul |
|
|
HB |
g/dl |
|
|
HCT |
% |
|
|
Differential |
40% Neutrophils |
|
|
60% Lymphocytes (26% reactive) |
||
|
PT |
18 |
sec |
|
PTT |
53 |
sec |
3) Discuss the clinical significance of the patient’sirritability and forgetfulness, PE findings (that haven’t alreadybeen addressed), clinical history, and the hematology labresults
Additional laboratory results were as follows:
|
CHEMSITRY |
|||||
|
Test |
Results |
Units |
Test |
Results |
Units |
|
Sodium |
140 |
mmol/L |
AST |
896 |
U/L |
|
Potassium |
4.0 |
mmol/L |
ALT |
999 |
U/L |
|
Chloride |
100 |
mmol/L |
LD |
550 |
U/L |
|
T. CO2 |
25 |
mmol/L |
ALP |
131 |
U/L |
|
Anion Gap |
15 |
GGT |
81 |
U/L |
|
|
Glucose |
80 |
||||
|
BUN |
16 |
T. Bilirubin |
10.0 |
||
|
Creatinine |
0.9 |
D. Bilirubin |
5.1 |
||
|
Uric Acid |
4.9 |
||||
|
Calcium |
10.2 |
||||
|
Phosphorus |
4.0 |
||||
|
T. Protein |
5.4 |
||||
|
Albumin |
2.9 |
||||
4. A. What type of hepatic condition(hepatocellular or hepatobiliary) is indicated by this patient’sliver enzyme data?
B. ALSO, explain how the liver enzymes can be used tohelp differentiate hepatocellular from hepatobiliary disease. (Bespecific)
