A 54-year-old woman had fatigue for 8 months and dark urine which noticed 6 weeks ago. Positive physical examination findings include scleral icterus, multiple spider telangiectasias over the chest and back, a liver edge palpated 4 cm below the right costal margin, and an enlarged spleen palpated 6 cm below the left costal margin. Results of complete blood count as well as measurement of serum electrolytes, urea nitrogen, and creatinine are normal. Other laboratory tests show: Alanine aminotransferase 78 U/L (10 - 40) Aspartate aminotransferase 680 U/L (10 - 30) Serum bilirubin 20.8 mg /dl (0.3 - 1.2) Direct bilirubin 8.7 mg/dl (0 - 0.2) Alkaline phosphatase 145 U/L (25 - 100) Serum albumin 2.8 g/dl (3.4 - 4.8) Serum protein 8.7 g/dl (6.4 - 8.3) Prothrombin time 12 sec (18 - 22) Which of the following diagnostic studies should be performed next?
سؤال مجاني 1 من 10 اليوم · اشترك وكمّل بدون حد
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الإجابة: C. Blood work for causes of Cirrhosis
Spider telangiectasias, hepatosplenomegaly (portal hypertension), low albumin and high globulin point to established cirrhosis, so the next step is to find its cause with targeted blood work: viral serology (HBsAg, anti-HBc, anti-HCV), iron studies, autoimmune markers (ANA, ASMA, IgG), ceruloplasmin/copper, alpha-1 antitrypsin, AMA. ALP is only mildly raised, so there is no obstructive picture to justify ERCP, and a HIDA scan is for acute cholecystitis. Cross-sectional MRI is not the next step; ultrasound/CT are the imaging tests used for cirrhosis.
- المصدر
- Cirrhosis -.pdf · p. 3
- المحاضرة
- Cirrhosis & Complications · Gastroenterology & Liver · Module C
- ظهر في
- GI bank