Basic Concepts in Clinical Biochemistry-A Practical Guide.7z

Ans: This is a case of obstructive jaundice due to cholelithiasis. Obstructive
jaundice is characterized by the absence of urobilinogen in urine as
explained above. In present case, the obstruction of bile ducts by gallstones
may have caused the absence of urobilinogen in urine.
Q.3. A 55-year-old man diagnosed with jaundice was brought to hospital. He had
complain of weight loss and passed pale stools. The laboratory investigation
showed:

Bilirubin–18 mg/dl

ALT–95 U/L

AST–75 U/L

ALP–330 U/L

Serum glucose–78 mg/dl

Urine was positive for bile salts and bile pigments. Give the probable

diagnosis.

Ans: Here bilirubin levels are very high with moderate elevation of AST and ALT
and greater increase of ALP. The urine shows the presence of bile salts and
bile pigments. All these diagnosis indicate obstructive jaundice.
Q.4. A young boy was brought to the hospital with history of vomiting, nausea,
loss of appetite, and abdominal pain. The laboratory data showed:

Bilirubin total–7.5 mg/dl

Indirect bilirubin–6.5 mg/dl

Direct bilirubin–4.2 mg/dl

ALT–78 U/L

AST–88 U/L

ALP–110 U/L

Urine was positive for bile pigments and urobilinogen and very dark in

color. Comment on report.

Ans: Bilirubin, AST, ALT, and ALP levels are significantly increased. Urine is
positive for bile pigments and urobilinogen. So, present case indicates
hepatocellular or hepatic jaundice. In hepatic jaundice, levels of both conju-
gated and unconjugated bilirubin rise in the blood. The abnormally high
amount of conjugated bilirubin and bile salts leads to their excretion in the
urine. This conjugated bilirubin provides the urine the dark color.
Q.5. A 35-year-old man with diagnosed jaundice and history of drug and alcohol
abuse was brought to hospital. He showed pitting edema. The blood investi-
gation report revealed:

Total protein–8.5 g/dl

Albumin–2.0 g/dl

Globulins–5.8 g/dl

Bilirubin–6.5 mg/dl

39.6 Case Studies of Liver Functions 163