The document discusses several cases presenting with abnormal liver function tests (LFTs). Case 1 shows a mild isolated transaminitis. Case 2 involves severe hepatocellular injury and mild cholestasis in an alcoholic patient. Case 3 examines LFT patterns in an alcoholic cirrhotic with possible alcoholic hepatitis.
ALT is an enzyme present in liver, heart skeletal muscles, highest concentration is present in Liver. it value increases when there is abnormality in liver, ALT is an amino transferase which transfer one amino group from an amino acid and transfer to another substance for production of non essential amino acid
Liver function tests (LFT’s) are groups of laboratory blood assays designed to give information about the state of patients liver
They include
Liver enzymes (SGOT, SGPT, ALP, GGT etc.,)
Bilirubin(Direct and indirect)
Albumin
Prothrombin time / INR
Importance of enzymes : The two aminotransferases that are checked are the alanine aminotransferase (ALT or SGPT) and aspartate aminotransferase (AST or SGOT). These liver enzymes form a major constituent of the liver cells. They are present in lesser concentration in the muscle cells.
ALT is an enzyme present in liver, heart skeletal muscles, highest concentration is present in Liver. it value increases when there is abnormality in liver, ALT is an amino transferase which transfer one amino group from an amino acid and transfer to another substance for production of non essential amino acid
Liver function tests (LFT’s) are groups of laboratory blood assays designed to give information about the state of patients liver
They include
Liver enzymes (SGOT, SGPT, ALP, GGT etc.,)
Bilirubin(Direct and indirect)
Albumin
Prothrombin time / INR
Importance of enzymes : The two aminotransferases that are checked are the alanine aminotransferase (ALT or SGPT) and aspartate aminotransferase (AST or SGOT). These liver enzymes form a major constituent of the liver cells. They are present in lesser concentration in the muscle cells.
GGT is one of a large group of enzymes “Peptidases”.
A membrane bound enzyme whose active site faces the external side of cell.
Hepatobiliary tract enzyme.
The liver is the largest organ in the body
It is located below the diaphragm in the right upper quadrant of the abdominal cavity and extended approximately from the right 5th rib to the lower border of the rib cage.
Renal function test (RFT), also known as kidney function test is a group of tests used to assess the functions of kidney.
It is used screen for, detect, evaluate and monitor acute and chronic kidney diseases.
These are simple blood and urine tests that are used identify kidneys problems.
Tests of renal function have utility in-
Identifying the presence of renal disease
Monitoring the response of kidneys to treatment
Determining the progression of renal disease
RFT is ordered, if your doctor
thinks your kidneys may not be working properly which is known from signs and symptoms
and if you have other conditions that can harm the kidneys, such as diabetes or high blood pressure
This presentation is about anemia of chronic disease, nowadays also called as anemia of Inflammation. I have dealt with anemia in CKD and malignancy in detail.
GGT is one of a large group of enzymes “Peptidases”.
A membrane bound enzyme whose active site faces the external side of cell.
Hepatobiliary tract enzyme.
The liver is the largest organ in the body
It is located below the diaphragm in the right upper quadrant of the abdominal cavity and extended approximately from the right 5th rib to the lower border of the rib cage.
Renal function test (RFT), also known as kidney function test is a group of tests used to assess the functions of kidney.
It is used screen for, detect, evaluate and monitor acute and chronic kidney diseases.
These are simple blood and urine tests that are used identify kidneys problems.
Tests of renal function have utility in-
Identifying the presence of renal disease
Monitoring the response of kidneys to treatment
Determining the progression of renal disease
RFT is ordered, if your doctor
thinks your kidneys may not be working properly which is known from signs and symptoms
and if you have other conditions that can harm the kidneys, such as diabetes or high blood pressure
This presentation is about anemia of chronic disease, nowadays also called as anemia of Inflammation. I have dealt with anemia in CKD and malignancy in detail.
BMS 561, Hematology Fall 2016 Case studiesThe following case .docxAASTHA76
BMS 561, Hematology Fall 2016 Case studies
The following case studies are not actual patients. They combine elements from different cases to emphasize important aspects
Case 1
HISTORY: Patient Presentation
A four-year-old African American male diagnosed with sickle cell disease in the newborn period was admitted to the hospital with abdominal pain. Two days prior to admission, he was seen in the emergency room for abdominal pain and sent out on pain medicine.
PHYSICAL EXAM
Height
100 cm (25th percentile on growth chart)
Weight
15 kg (25th percentile on growth chart)
Temperature:
38.9ºC
Heart Rate:
135
Respiratory Rate:
40
Blood Pressure
100/60 mmHg
Oxygen Saturation Level:
87% (normal range: 92%-98%)
HEENT:
Normocephalic, pupils reactive, tympanic membranes clear, oropharynx clear
Neck:
No adenopathy
Chest:
Mild subcostal retractions. Audible rales at lung bases.
Heart:
Tachycardic with III/VI murmur
Abdomen:
Mild distension, diffusely tender to palpation
Genitourinary:
Circumcised male, no priapism
Extremities:
Warm
Neurologic:
Crying, alert boy. Face was symmetric. Moved all extremities.
LABORATORY DATA
Patient Value
Normal Value
WBC
15,000
4,000-12,000/μL
HGB
6.3
11.5-13.5 g/dL
HCT
18
34%-40%
PLT
560,000
140,000-440,000/μL
MCV
89.0
75-87 fl
Retic %
14%
0.5%-1.5%
Rectic Absolute
0.2125
0.024-0.084 M/μL
1 What history, including symptoms, would be most helpful in evaluating this patient?
2 What does a prior history of abdominal pain reflect? What does Bone pain and swollen, painful fingers (dactylitis) reflect in this disease?
3 He had a temperature of 101 degrees Fahrenheit yesterday.what does that indicate?
4 He has been coughing 2-3 times a day and intermittently through the night.what does that indicate??
5 Does family history indicate sickle disease?
6 What additional physical findings might occur in patients with sickle cell disease? Discuss Jaundice and Splenomagaly??
7 What other labs would you request? Compare the lab findings with normal ranges
Discuss Peripheral smear, hemoglobin electrophoresis,
Blood culture; Blood Type and screen for antibodies
LDH; Haptoglobin levels
Amylase and Lipase
8 Discuss MCV, MCH, RDW, ESR, Hematocrit and red cell morphology in this disease
9 What was your differential diagnosis when you first saw the patient? Discuss the following in diagnosing the disease
Cholecystitis; Pneumonia; Upper respiratory tract infection; Vaso-occlusive pain crisis
10 what are the differences between sickle cell disease, HbC, HbE and Thalassemia diseases?
11 Discuss Iron deficiency anemia, thalassemia syndromes and sickle cell anemia
12 How would you treat this patient?
Case 2
On review of symptoms, The patient reports difficulty concentrating, fatigue, feeling faint when she stands quickly, and vague gastrointestinal discomfort with some decrease in appetite.
She denies any history of previous trauma, diplopia, dysphagia, vertigo, vision loss, loss of consciousne ...
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6. Case #1 A 45 year-old male presents to your Bellevue clinic to establish care. He has not seen a doctor in over 10 years, but has been feeling well. He is unaware of any medical history. His exam is unremarkable. His labs are normal except for the LFTs below: 77 85 0.6 7.8 71 0.2 4.1
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11. Case #2 A 20 year-old female was found down in her apartment when she did not show up to her first day of class after winter break. Her apartment has evidence of empty bottles of alcohol. No pill bottles were found. In the ER she was acutely jaundiced, unresponsive, but hemodynamically stable. 1218 191 3.8 7.8 1055 1.6 3.6
17. Case #3 A homeless 63 year-old male with ETOH cirrhosis is brought in by NYPD for disorderly conduct. He endorses diffuse abdominal pain. He is afebrile and tremulous. His WBC count is elevated. His ETOH level is 0. 221 135 4.1 6.2 103 2.2 3.2
25. Case #4 You are medical consult asked to evaluate a G1P0 female at 28 3/7 weeks for A mild pruritic maculopapular rash on the extremities and for the abnormal LFTs below. You learn that these LFTs are new from 1 year ago, but similar to those from her last outpatient appointment 2 weeks ago. 25 213 1.1 8.2 18 0.3 3.8
32. Case #5 A 21 year-old man presents with recurrent episode of sinusitis. He is otherwise healthy; you prescribe amoxicillin. He returns the following week jaundiced and with continued sinus tenderness. 21 115 3.9 7.5 24 0.4 4.1
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37. Case #6 A 30 male with schizophrenia on depakote for several months, presented with abdominal pain and yellow eyes for two weeks. He denies changes in stool, nausea, vomiting, fever. Had normal LFTs 3 months ago. 149 281 4.2 7.1 332 3.8 3.9
42. Case #6 Discussion Management of Cholestasis with ductal dilation ? ERCP vs. MRCP Intrahepatic Dilation Extra Hepatic/CBD Dilation Pancreatic Duct Dilation PBC -- -- -- PSC +/- +/-- -- Asian Cholangiopathy + -- -- CBD Stricture + + +/ -- Choledocholithiasis + + +/ -- Pancreatic Mass + + +
43. Case #7 A 28 year-old woman comes in for a refill of her oral contraceptives. She has mild scleral icterus. 28 212 4.1 7.7 22 3.0 4.2
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46.
47. Case #8 A 68 year-old female with CAD, HTN, pulm HTN, DM II is admitted from clinic for vague constitutional symptoms and workup of the LFTs found below. She denies recent change in medications. 78 904 1.6 6.6 74 1.0 3.6
52. Case #9 A 63 year-old African American Male with diabetes presents to your clinic for the first time complaining of back pain 47 87 0.6 11 51 0.2 4.2
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56. Case #9 Discussion Alpha-1 fraction= alpha-1 antitrypsin, thyroid binding globulin. Alpha-2 fraction= ceruloplasm, haptoglobin. Beta-1= tranferrin Beta-2= beta-lipoprotein [IgA, IgM, even IgG at times]. Between Beta and Gamma= CRP, fibrinogen. Gamma= immunoglobulins
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