case study tutorials on clinical
chemistry
case 1 ANS:
what is the best description of the pattern of these results?
-bilirubin high
-ALT & ALP moderately raised
-ALP very high 4 x the normal range
-albumin very slightly low
-gamma GT very high 15 x normal range ANS: cholestatic picture
in obstructive jaundice - what will the ratio of conjugated to unconjugated bilirubin be? ANS: more
conjugated than unconjugated
this is because the liver is ok and the problem lies beyond the liver, so the liver can still conjugated the
bilirubin
what are the common causes of cholestatic jaundice? ANS: caused by bile duct obstruction
-malginancy (cholangiocarcinoma, pancreatic carcinoma)
-gallstones
-sclerosing cholangitis
-pancreatitis +/- pseudocyst
what are the important clinical features of cholestatic jaundice? ANS: painful (gallstones, pancreatitis)
vs painless
, bilirubin clinically detectable at >50 umol/L
pale stools and dark urine
ALP >> ALT
conjugated bilirubin > unconjugated
case 1
-56 yo man
-malaise and pruritis
-unwell over few weeks
-urine dark
-obstructive picture
what is the most likely cause of jaundice? ANS: carcinoma of the head of the pancreas
case 2 ANS:
what abnormality do these results show?
-low T3 and T4
-v high TSH 8 x normal range ANS: primary hypothyroidism
what is the cut off for bilirubin becoming visible? ANS: 50
how is hypothyroidism managed? ANS: diagnosis of hypothyroidism is made and the patient is
prescribed levothyroxine 50 micrograms orally daily
chemistry
case 1 ANS:
what is the best description of the pattern of these results?
-bilirubin high
-ALT & ALP moderately raised
-ALP very high 4 x the normal range
-albumin very slightly low
-gamma GT very high 15 x normal range ANS: cholestatic picture
in obstructive jaundice - what will the ratio of conjugated to unconjugated bilirubin be? ANS: more
conjugated than unconjugated
this is because the liver is ok and the problem lies beyond the liver, so the liver can still conjugated the
bilirubin
what are the common causes of cholestatic jaundice? ANS: caused by bile duct obstruction
-malginancy (cholangiocarcinoma, pancreatic carcinoma)
-gallstones
-sclerosing cholangitis
-pancreatitis +/- pseudocyst
what are the important clinical features of cholestatic jaundice? ANS: painful (gallstones, pancreatitis)
vs painless
, bilirubin clinically detectable at >50 umol/L
pale stools and dark urine
ALP >> ALT
conjugated bilirubin > unconjugated
case 1
-56 yo man
-malaise and pruritis
-unwell over few weeks
-urine dark
-obstructive picture
what is the most likely cause of jaundice? ANS: carcinoma of the head of the pancreas
case 2 ANS:
what abnormality do these results show?
-low T3 and T4
-v high TSH 8 x normal range ANS: primary hypothyroidism
what is the cut off for bilirubin becoming visible? ANS: 50
how is hypothyroidism managed? ANS: diagnosis of hypothyroidism is made and the patient is
prescribed levothyroxine 50 micrograms orally daily
