Viral Hepatitis Or Hepatic Jaundice, Obstructive Jaundice, Acute Pancreatitis, Jaundice, Case Studies

Viral Hepatitis Or Hepatic Jaundice

Case 1: Flue-Like Symptoms

An 18 years old boy having flu-like symptoms came to OPD with nausea, vomiting, and yellow discoloration of skin and sclera.

• On Laboratory investigation
• SGPT– 698 IU/L.
• SGOT– 729 IU/L.
• ALP– 316 IU/L.
• Serum Bilirubin– Direct– 8.6 mg/dl, Indirect– 7.1 mg/dl.
• Diagnosis– Infective hepatitis or hepatic jaundice.
• Liver-specific enzyme– SGPT or ALT.

Read And Learn More: Biochemistry Clinical Case Studies With Answers

SGOT and SGPT

1. Transaminases.
2. Normal level SGOT– 8–20 IU/L and SGPT– 5–35 IU/L.
3. SGOT and SGPT belong to plasma nonspecific enzymes.
4. Concentration in serum increases whenever there is necrosis, proliferation, or damage to the hepatic cells.
5. Very high values in thousands are seen in acute hepatitis.

Van Den Bergh’s Reaction

1. Bilirubin reacts with diazotized sulfanilic acid to produce azobilirubin which is pink-purple in colour.
2. Direct reaction is given by conjugated bilirubin immediately, no solubilizer is required.
3. Indirect reaction is given by unconjugated bilirubin (water insoluble) and takes time, solubilizer (methanol, caffeine) is required.

Case 2: Abdominal Pain And Vomiting

A 25 years old girl who was staying in the hostel presented with chief complaints of abdominal pain and vomiting. Her blood levels showed increased bilirubin levels and the presence of urobilinogen in urine.

Question 1. Name the test done for bilirubin and state its principle.
Answer:

Diazo reaction or Van den Bergh’s reaction. Name of method– Malloy and Evelyn’s method or Jendrasik and Grof’s method

Obstructive Jaundice

Question 1. What are the causes of obstructive jaundice?
Answer:

1. Common bile duct (CBD) stones (most common).
2. Gallstone.
3. Cholangiocarcinoma.
4. Cancer of the head of the pancreas.
5. Stricture of CBD (inflammatory, postoperative or post-radiotherapy), etc.

Case 1: A 65-year-old man came to the hospital with complaints of abdominal pain, pruritus, and yellow-colored urine.

On laboratory investigations (Blood tests):

• SGPT– 68 IU/L.
• SGOT– 72 IU/L.
• ALP– 986 IU/L.
• Serum Bilirubin– Direct- 16 mg/dl, Indirect- 2.1 mg/dl.
• Diagnosis– Obstructive jaundice.
• Enzymes indicating Obstructive pathology– ALP, 5’-Nucleotidase (5’-NT)

Alkaline Phosphatase

1. Normal range– 40–125 IU/L in adults.
2. Up to 375 IU/L in children.
3. A moderate increase (2–3 times normal) is seen in hepatic diseases.
4. High levels (10–12 times normal) are seen in obstructive jaundice.
5. Reason for increase in ALP activity in obstructive jaundice.
6. ALP is an ectoenzyme, present on the cell surface and produced by the epithelial cells of biliary canaliculi.
7. Obstruction of the biliary passage causes irritation of biliary cells and edema of hepatic cells compresses the knobs of biliary canaliculi that cause release of ALP in serum.

Obstructive jaundice Other Laboratory Test

1. SGOT.
2. SGPT.
3. Total protein.
4. Albumin and A/G ratio.
5. Serum bilirubin Total/direct/Indirect.

Case 2

A 50 years old man was admitted with recurrent pain in his abdomen, which developed jaundice two days after admission. Ultrasonography reveals an enlarged head of the pancreas. A routine urine examination show the presence of bile pigments but urobilinogen was absent. Stool examination revealed chalky white colored stools.

Question 1. What is the most likely cause?
Answer:

Carcinoma of the head of the pancreas compressing the biliary tree.

Question 2. Explain the findings in urine.
Answer:

Urine will be positive for bile salts and bile pigments.

Acute Pancreatitis

It is a disease in which the pancreas becomes inflamed.

The important role of the pancreas in our body

1. It releases digestive enzymes into the small intestine.
2. It releases insulin and glucagon into the bloodstream.

Clinical Features Of Pancreatitis

Pain in the upper part of the abdomen that radiates to the back, eating fatty food makes it worse. Fever, nausea, vomiting, etc.

Pancreatitis Treatment

Antibiotics, IV fluid, low-fat diet, Surgery if needed.

Case 1

A 55-year-old male presents to the casualty department with complaints of nausea, vomiting, and pain in the epigastric and right upper quadrant of the abdomen. The pain was severe, disturbing, and relieved by crouching. Laboratory investigation

• Serum amylase– 729 IU/L.
• Diagnosis– Acute Pancreatitis.
• The enzyme is specific to Pancreatitis– Serum lipase.
• Normal amylase level is– 50–120 IU/L.

Acute Pancreatitis:

Amylase level reaches a peak in 5–12 hours after onset of disease and returns to normal within 3–4 days.

• Value reaches up to 1000 and more in acute attacks.
• Serum lipase is more specific than amylase.

 

Acute Myocardial Infarction

Case 1: A 38 years old man, a chronic smoker, had a sudden onset of chest pain and perspiration.

1. ECG shows ST elevation and T wave inversion.
2. Serum CK MB levels were increased.
3. Diagnosis– Acute Myocardial Infarction.
4. Other enzymatic markers– LDH 1, SGOT.
5. Other markers– Serum Troponin I and T.
6. Earliest enzymatic marker to rise– CK-MB.
7. Most specifically– Cardiac Troponins.

Important Markers in Myocardial Infarction

Myocardial Infarction Case 2

A 55-year-old executive reported severe chest pain and was admitted to the hospital. Investigations showed ECG changes and block in the artery and his laboratory findings showed a cholesterol level of 300 mg% and LDL cholesterol was 250 mg%.

Question 1. What is the probable diagnosis?
Answer:

Acute Myocardial infarction.

Question 2. Which further biochemical investigations should be carried out to establish the diagnosis?
Answer:

• Lab investigations.
• Cardiac markers– CK-MB, Troponin T, Troponin I, LDH1.
• Lipid profile– TG, HDL.
• Screening of other family members for familial hyperlipidemia– TG, Cholesterol, HDL, LDL, VLDL.

Question 3. What dietary advice can be offered to such patients?
Answer:

• Avoid smoking.
• Healthy lifestyle.
• Diet modifications– reduce dietary cholesterol, moderate fat intake, vegetable oil, and PUFA consumption, increase dietary fibers, and avoid trans-fatty acids.
• Maintain a normal weight.
• Medications– statins to lower cholesterol levels.