ALT–305 U/L
AST–210 U/L
ALP–175 U/L
Blood urea nitrogen–6.0 mg/dl
Urine was positive for bilirubin. Comment on report.
Ans: The laboratory data presents with abnormal liver function tests. The signifi-
cant elevation of AST and ALT reflects chronic liver disease. In acute liver
disease, transaminase levels are much higher but remain moderately higher
in chronic liver disease due to destruction of hepatocytes. Low value of
albumin and blood urea nitrogen suggests impaired synthesis due to loss of
hepatocytes. Overall, it is a probable case of chronic hepatitis.
Q.6. A case with the following laboratory results was presented in a meeting:
Serum bilirubin–9.0 mg%
Conjugated bilirubin–0.5 mg%
Unconjugated bilirubin–8.5 mg%
ALT–30 U/L
AST–35 U/L
ALP–10 KAU
Urine showed negative test for bile salts and bile pigments but positive (++)
for urobilinogen. Feces stercobilinogen was also positive. Comment on
the case, and give the provisional diagnosis.Ans: This is a case of hemolytic jaundice caused by high destruction of red blood
cells. In prehepatic or hemolytic jaundice, the unconjugated bilirubin is
increased due to increased destruction of red blood cells, and the liver is
unable to cope with the increased demand for conjugation. Hence, deposi-
tion of this unconjugated bilirubin occurs into various tissues leading to a
jaundiced appearance. Urine is deprived of bilirubin because unconjugated
bilirubin is not water-insoluble, so increased urine urobilinogen without
bilirubin in urine is suggestive of hemolytic jaundice. The increased hemo-
lysis of blood cells produces high bilirubin leading to the increased excretion
of urobilinogen in urine.
Q.7. A 30-year-old man was diagnosed with the presence of gallstones. He had
severe abdominal pain also. The laboratory investigations showed:
RBCs: 3 million/cu mm
Reticulocytes: 14%
Hemoglobin: 8.2 g/dl
Serum bilirubin (total): 2.6 mg/dl
The urine was positive for urobilinogen. Comment on probable diagnosis.Ans: The case indicates severe hemolytic anemia, leading to bilirubinemia. Excre-
tion of large quantities of bilirubin through bile leads to gallstones, made up
of bilirubin. Decreased life span leads to active generation of RBCs, hence
increased reticulocytes.
164 39 Some Important Case Studies