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Old 08-25-2012
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A 63 year old man presents with several weeks of vague abdominal pain.He also complains of increased fatigability.His past medical history is not significant.He smokes one pack of cigarettes a day and consumes five to six cans of beer on weekends.His mother died of a stroke and his father died of a myocardial infarction.Physical examination reveals a mildly distended ,sof abdomen.The liver edge is firm and is palpated 5 cm below the costal margin .Hepatomegaly reflex is absent .Trace ankle edema 5cm below the costal margin.Hepatojugular reflex is absent .Trace ankle edema is also present.laboratory findings are :
Haemoglobin 9g/l
MCV 70fL
leuckocyte count 4,500/mm3
BUN 19
Creatinine serum 0.8mg/dl
Aspartate aminotransferase 48U/L
Alanine aminotransferase 56
Alkaline phosphate 320 U/L

Coagulation studies with normal limits.Chest xray shows a small left-sided pleural effusion.Fecal occult blood test is positive.Which of the following is the most likely cayse of hepatomegaly in this patient?

A.Portal hypertension
B.Left ventricular fuilure
C.Pulmonary hypertension
D.Alcoholic cirrhosis
E.Non alcoholic steatohepatitis
F.Metastatic disease
G.Autoimmune hepatitis
H.Hemochromatosis
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Old 08-25-2012
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Also provide reasoning ,to contribute to a discussion
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Old 08-25-2012
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metastatic disease

elderly,microcytic anaemia, FOBT positive----colon cancer(right sided may be)
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Old 08-25-2012
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Quote:
Originally Posted by step_enhancer View Post
A 63 year old man presents with several weeks of vague abdominal pain.He also complains of increased fatigability.His past medical history is not significant.He smokes one pack of cigarettes a day and consumes five to six cans of beer on weekends.His mother died of a stroke and his father died of a myocardial infarction.Physical examination reveals a mildly distended ,sof abdomen.The liver edge is firm and is palpated 5 cm below the costal margin .Hepatomegaly reflex is absent .Trace ankle edema 5cm below the costal margin.Hepatojugular reflex is absent .Trace ankle edema is also present.laboratory findings are :
Haemoglobin 9g/l
MCV 70fL
leuckocyte count 4,500/mm3
BUN 19
Creatinine serum 0.8mg/dl
Aspartate aminotransferase 48U/L
Alanine aminotransferase 56
Alkaline phosphate 320 U/L

Coagulation studies with normal limits.Chest xray shows a small left-sided pleural effusion.Fecal occult blood test is positive.Which of the following is the most likely cayse of hepatomegaly in this patient?

A.Portal hypertension
B.Left ventricular fuilure
C.Pulmonary hypertension
D.Alcoholic cirrhosis
E.Non alcoholic steatohepatitis
F.Metastatic disease
G.Autoimmune hepatitis
H.Hemochromatosis
F metastatic disease bcz of anemia and positive occult blood test, and may left pleural effusion

A, D are excluded by the absence of risk factors of chronic liver disease(Long standing history of alcohol abuse, viral hepatitis).
B, C no correlation with the case.
E excluded by the absence of risk factor of hyperlipidemia, obesity and D.M.
G should be expected when we have other autoimmune dieseas.
H genetic disorder cc by infertility, restrictive cardiomyopath, D.M. etc.
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Old 08-26-2012
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Anyone..... ?
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metastatic disease. his liver panel doesnt show inflammation like the one seen in cirrhosis or autoimmune hep. liver's working ok-clotting factors are being made. lack of HJ reflex means no PHTN. MI doesnt present like this-think sweatiness, palpitations, ST elevations in 1,avl,, v5,v6. nothing for us family hx wise for us to think of hemochromatosis.
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Metastatic Disease, this dude probably has colon cancer, and he is anemic so we must rule out that first, also guiac is positive so..

Portal hypertension is ruled out because we dont have hepatojugular reflux and caput medusae in his belly.

there is no way alcoholic hepatitis would cause this scenario.

Hemochromatosis is also known as bronze diabetes so we would see a change in his skin color, tiny testicles plus alteration in sugar levels.
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Quote:
Originally Posted by anomali View Post
metastatic disease

elderly,microcytic anaemia, FOBT positive----colon cancer(right sided may be)
Yes correct answer is F. Metastatic disease
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