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Old 11-27-2011
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Question Challenging Gastroenterology/surgery/obstetrics question

Hi everyone, I am currently on my clinical surgery rotation. The surgeon I am rotating with placed a very interesting/challenging case on a 36 yearold female who has a history of injury to her biliary ducts while performing a laparoscopic cholecystectomy. As a consequence to this, the same surgeon performed a right and left hepatic-jejunostomy and a metallic stent was placed in each anastomisis.

The patient was discharged since there was improvement but returned a year later because she developed obstructive jaundice. After several studies there was no dilation od the hepatic and biliary ducts but there was obstruction at the level of the anastomisis. She went under surgery for revision and the surgeon realized the stents were occluded by sediments/sludge. The stents were removed and a right and left hepatic-dudenostomy was performed.

The obstrucive jaundice she came with was resolved but her lab results are:


Alkaline Phosphatase: 1226 (high)
AST: 135 (high)
ALT: 224 (high)
Albumin 3.90 gr/dl (normal)
Direct bilirubin 0.40 mg/dl (normal)

The patient is on her 8th week of pregnancy and currently asymptomatic.

The question is why are her lab results showing Alkaline Phosphatase, AST, ALT so elevated.?

What are her risks for the pregnancy?

Management?
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  #2  
Old 11-28-2011
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Question

blocked biliary tree ---> increase in alkaline phosphatase

back flow of biliary secretions ---> biliary hepatitis increase in alt n ast...

biliary hepatitis ...... loss of proteins... including ferritn n hemoglobin...

leading to decreased blood supply to embryo....

managemnt.... biliary resins...????

keep posted.....
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The above post was thanked by:
meanmr.mustard (11-29-2011)
  #3  
Old 11-29-2011
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Quote:
Originally Posted by anonyme View Post
blocked biliary tree ---> increase in alkaline phosphatase

back flow of biliary secretions ---> biliary hepatitis increase in alt n ast...

biliary hepatitis ...... loss of proteins... including ferritn n hemoglobin...

leading to decreased blood supply to embryo....

managemnt.... biliary resins...????

keep posted.....
Thanks for the attempt on figuring out this case. Your theory makes sense.

What I don't understand is 'why is this patient with jaundice, given that her bilirubin levels are within normal ranges, and why are her liver function tests and alk. phosph. elevated??

I still haven't seen the surgeon who presented this case, but if I will let you know whenever I receive an explanation.
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