LIVER Exam Questions With Complete Solutions

1) A 61 year-old man lost 8 kg during the last 4 months. He complains of pruritus and frequently occurring dull epigastric pain. He has noted dark-colored urine, but light colored stools lately. He has jaundice. The gall bladder is palpable, but non-tender. Laboratory results: serum bilirubin: 310 µmol/l, mostly direct urine Ubg: negative ASAT: 82 U/l ALAT: 91 U/l alkaline phosphatase: 540 U/l prothrombin time: INR = 2.6 What is the cause of his jaundice? What further tests do you consider? correct answer: - Lost 8 kg the last 4 months --> suspect cancer - Pruritus; itching. This itching happens because the biliary obstruction results in leaking of bile acids into the circulation and their accumulation in the skin. - Courvoisier's law/ sign states that in the presence of a palpably enlarged gallbladder which is non-tender and accompanied with mild painless jaundice, the cause is unlikely to be gallstones. no tender indicates malignancy. tenderness is a better sign indicating inflammation or gallstone. - Courvoisier's law/ sign: caused most often by the carcinoma of the head of the pancreas, close to the biliary tract, and can cause biliary obstruction. * Jaundice because serum bilirubin is greater than 50 micromol/l * Gall bladder palpation * non tender -Bilirubin = very high --> significant jaundice - Mostly direct: mostly conjugated bilirubin - Ubg: negative --> suggest total obstruction - Parenchymal enzymes: moderate elevated - ALP: very high --> favors biliary obstruction - Prothrombin time: increased, caused by 2 things: significant liver damage/biliary obstruction * because of enzymes suggest biliary obstruction, we believe so too - the urine is dark because of conjugated bilirubin in the urine. - light stool because no bile excretion to the GIT - no cB in the