2. Diagnosis Case ( 19 hours)
Edero2103
Cholelithiasis.docx( Pagana: Mosby’s Manual of Diagnostic and Laboratory Tests, 5th Edition Gallbladder and Common Duct Stones )
Case Studies
The patient, a 44-year-old mother of seven children, was an obese woman. Two weeks before she was admitted to the hospital, she began to complain of right upper quadrant abdominal pain associated with nausea and vomiting. Two days before admission she noticed that her urine was very dark and her stools were lighter in color. The results of her physical examination revealed she was mildly icteric. Her abdominal examination results indicated mild upper abdominal tenderness and muscle guarding. No other abnormalities were noted during her physical examination.
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Studies |
Results |
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Complete blood cell count (CBC), electrolyte, glucose, and blood urea nitrogen (BUN) determinations, p. 174 |
Normal |
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Total serum bilirubin determination, p. 121 |
3.8 mg/dL (normal: 0.1-1.0 mg/dL) |
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Indirect fraction |
1.0 mg/dL (normal: 0.2-0.8 mg/dL) |
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Direct fraction |
2.8 mg/dL (normal: 0.1-0.3 mg/dL) |
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Urine bilirubin test, p. 1013 |
+3 (normal: negative) |
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Liver enzymes test |
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Serum aspartate aminotransferase (AST), p. 119 |
46 International units/L (normal: 5-40 International units/L) |
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Serum alanine aminotransferase (ALT), p. 39 |
40 International units/L (normal: 5-35 International units/L) |
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Lactic dehydrogenase (LDH), p. 329 |
228 units/L (normal: 90-200 units/L) |
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Alkaline phosphatase (ALP), p. 47 |
885 units/L (normal: 30-85 units/L) |
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5ʹ-Nucleotidase, p. 376 |
2.4 units (normal: 0-1.6 units) |
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Leucine aminopeptidase (LAP), p. 337 |
250 units/mL (normal: 75-185 units/mL) |
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Serum gamma-glutamyl transpeptidase (GGTP), p. 246 |
250 units/L (normal: 5-27 units/L) |
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Total serum protein test, p. 424 |
7.2 g/dL (normal: 6-8 g/dL) |
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Serum albumin test, p. 424 |
4.2 g/dL (normal: 3.2-4.5 g/dL) |
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Prothrombin time (PT) test, p. 434 |
14.2 seconds (patient); 12.0 seconds (control) |
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Ultrasound examination of the liver and gallbladder, p. 866 |
Dilated intrahepatic and extrahepatic bile ducts; presence of stones within the gallbladder |
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Endoscopic retrograde cholangiopancreatography (ERCP), p. 605 |
Dilated common bile duct containing a gallstone |
