workshop final

21 day old baby boy with family history of g6pd deficiency is brought to ER. Mother applied henna to his body yesterday. Lethargy and jaundice also developed. Lab tests revealed low hemoglobin, high serum T-BIL, and darker urine and feces

What caused the patients hyperbilirubinemia?

henna being applied and a G6PD deficiency causing hemolytic lysis

Predict serum levels of conjugated (D-BIL) and unconjugated (I-BIL test)

Normal D-BIL

Increased I-BIL

Increased level causes dark color urine

Urobilin

Increased level causes dark color feces

Stercobilin

Predict LFTs with this patient

Normal ALT, GGT, and Albumin

69 year old man has fatigue, ab discomfort, and itchy rash. 3 weeks ago he took amoxicillin for bronchitis. Lab tests showed high ALK, high AST, high ALT, high T-BIL, high GGT, and low albumin

Amoxicillin causes vanishing bile duct syndrome - leading to cholestasis. What two lab tests support idea that the patient may have developed this syndrome?

T-BIL being increased

GGT and ALK both elevated are more specific marker of cholestasis

Predict how vanishing bile duct syndrome will affect serum levels of conjugated (D-BIL test) and unconjugated (I-BIL test) bilirubin:

Increased D-BIL
Normal I-BIL

In a typical diagnostic profile of this disease, D-BIL is increased and I-BIL is normal unless there is a prolonged case causing liver damage.

54 year old woman presents with an 8 week history of fatigue and unintentional weight loss. Denies tobacco or drug use. Drinks one to two glasses of wine. Patient also says she took black cohosh. Lab tests showed:

High AST, ALT, ALK, GGT, T-BIL, PT

Low albumin

Patient hospitalized and blood work gets worse. Explain serum levels of conj. and unconj. bilirubin

Increased D-BIL and I-BIL

Why the high GGT?

Cholestasis likely from black cohosh

Is the patients biosynthetic function impaired?

Yes

Which combos of lab tests best supports your answer?

Albumin and PT

Speculate on liver damage

Toxic hepatic injury from black cohosh