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  #1  
Old 08-04-2011
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Liver Liver Disease Diagnostic Dilemma!

A 60 year old male carpenter has been heavily drinking since he was 15. He has long standing complaints of weakness and weight loss. His condition worsens and he develops extreme nausea, anorexia and abdominal pain. On physical exam, his liver is enlarged and firm. He has numerous spider nevi. His laboratory results show a macrocytic anemia, elevated liver enzymes, elevated alkaline phosphatase and a negative alpha fetoprotein. What is the most likely condition?

a)
pancreatic carcinoma
b)
hemochromatosis
c)
Laennec's cirrhosis
d)
hepatitis A
e)
hepatocellular carcinoma
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  #2  
Old 08-04-2011
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Laennec's cirrhosis
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  #3  
Old 08-05-2011
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c) alcoholic cirrosis
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  #4  
Old 08-05-2011
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C.laennec cirrhosis
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  #5  
Old 08-05-2011
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Why is the anemia macrocytic?
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  #6  
Old 08-05-2011
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Quote:
Originally Posted by usluipek View Post
Why is the anemia macrocytic?
it is called as nonmegaloblastic macrocytic anemia, occurs in liver dis...
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  #7  
Old 08-05-2011
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I agree

yup its C
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  #8  
Old 08-05-2011
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never even heard about leaenec cirrhosis.
my guess is pancreatic Ca!
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  #9  
Old 08-05-2011
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is it C ?
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  #10  
Old 08-05-2011
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Quote:
Originally Posted by salz View Post
never even heard about leaenec cirrhosis.
my guess is pancreatic Ca!
it is when there is a gradual shift from micronodular to macronodular
bt here is it cirrhosis only...
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Old 08-05-2011
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Quote:
Originally Posted by usluipek View Post
Why is the anemia macrocytic?
Probably B12 deff.
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Old 08-05-2011
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Quote:
Originally Posted by akua View Post
Probably B12 deff.
it is called as nonmegaloblastic macrocytic anemia, occurs in liver dis...
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  #13  
Old 04-08-2012
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Based on the given criteria, it could be difficult to answer which one is the most likely condition.

Positive history of alcoholism

together with signs such as
- spider naevi,
- anaemia,
- raised liver enzymes

-- can not specifically suggest higher likelyhood of any one of the conditions- HCC or Laennec's cirrhosis.

Negative AFP could perhaps add more information. However, many evidences have shown that the sensitivity of AFP in detection of HCC ranges between 20- 60% in different studies. This means many cases of HCC can have negative AFP. Conversely, AFP can be positive in significant portion of alcoholic cirrhosis cases.

So evidence inspires to think that this one is not a good question and Laennec's cirrhosis is not a good answer. Good question could be by specifying high levels of AFP(>400 ng/ml), strongly indicative of HCC. Though feel free to share if you got different opinion.
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  #14  
Old 04-08-2012
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but let's say with equal presentations, wouldn't Laennec's cirrhosis be statistically more frequent than HCC?
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Old 04-08-2012
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Quote:
Originally Posted by slumdog View Post
However, many evidences have shown that the sensitivity of AFP in detection of HCC ranges between 20- 60% in different studies. This means many cases of HCC can have negative AFP. Conversely, AFP can be positive in significant portion of alcoholic cirrhosis cases.

I was thinking that also... negative AFP does not equal no HCC...
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Old 04-08-2012
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I feel its HCC, although the presented scenario fits both HCC and cirrhosis. negative AFP does make us think of cirrhosis as the option but AFP s positive in 70% cases of HCC only......its not conclusive of HCC neither u can rule out HCC by just one point- negative AFP.

I would have picked HCC for sure.........overall a poorly organised question i feel
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Old 04-09-2012
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Default Raised Alp, pain abd, weight loss, ch alcoholic

Pancreatic ca...
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  #18  
Old 04-09-2012
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Quote:
Originally Posted by BritneySpears View Post
but let's say with equal presentations, wouldn't Laennec's cirrhosis be statistically more frequent than HCC?

Ya, I think that's perhaps an relevant aspect as well. I doubt whether one who formulated this question, expected anyone to base their answer on epidemiology of the two diseases.

In context of the US, it's true to reason the answer by higher occurrence of alc cirrhosis compared to HCC.

Though globally, the answer can vary depending upon population context. Some populations have shown higher and even increasing incidence of HCC(and cirrhosis) due to hepatitis C, B or concomitant hepatitis C and B infections.
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