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Old 02-01-2012
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Liver Can you guess the cause of this jaundice?

A 27-year-old man comes to the physician for a routine health maintenance examination. He says he feels well and has not had any problems. He has no history of serious illness. He occasionally takes acetaminophen for headaches. His brother had kidney failure at the age of 32 years. There is no family history of liver disease. The patient does not smoke. He occasionally drinks a beer or a glass of wine. He has never used intravenous illicit drugs. He has had 10 lifetime male sexual partners and uses condoms consistently. He has been in a monogamous relationship for the past 3 years. His temperature is 37C (98.6F), pulse is 72/min, and blood pressure is 118/70 mm Hg. Examination shows no abnormalities except for mild scleral icterus. Laboratory studies show:

Hematocrit44%
Leukocyte count5000/mm3
Prothrombin time11 sec (INR=1)
SerumNa+141 mEq/L
Serum K+4.2 mEq/L
Serum Cl104 mEq/L
Serum HCO324 mEq/L
Urea nitrogen14 mg/dL
Creatinine0.8 mg/dL
Bilirubin, total3.0 mg/dL
Direct0.2 mg/dL
AST
14 U/L
ALT15 U/L
Serologic testing for hepatitis A and B is negative.
Abdominal ultrasonography shows no abnormalities.

Which of the following is the most likely cause of these findings?

A. Decreased conjugation of bilirubin
B. Decreased excretion of bilirubin by hepatocytes
C. Decreased intracellular storage of bilirubin
D. Delayed uptake of bilirubin
E. Hemolysis

Please explain what is the relation the brothers kidney failure
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Old 02-01-2012
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D. Gilberts?
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Old 02-01-2012
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Default sabs_49

D I Think
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Old 02-01-2012
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D). for Gilberts... ?? and bro's kidney failure is a distractor , i guess..
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Old 02-01-2012
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A. i Think NonHemolitic Hyperbilirubinemia Criggler Najjar. Autosomal Receive Disease. UDP transf def
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Old 02-01-2012
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the answer is A .... thrs no explanation given.... its from the usmle practice material.... anybody know the association with the kidney, or is it just a dis-tractor.... also, in gilbert is thr a conjugation problem or an uptake problem, coz both gilbert and crigler-najar have hv the same enzymatic problem , gluronyl transferase.....
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Old 02-01-2012
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i think it is A. GILBERT SYNDROME, unconjugated hyperbilirubinemia due to decrease UDP activity needed for conjugation.

Criggler najar would be severe form with complete absence of UDP activity incompatible with life.

And i think kidney problem in the brother is a distractor
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Old 02-01-2012
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check this out:

Can you guess the cause of this jaundice?-bilirubin.png
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The above post was thanked by:
Al-Saoudi (02-02-2012), gargabhi2 (02-01-2012), pass7 (02-01-2012)



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Gastroenterology-, Internal-Medicine-, Step-2-Questions

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