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Old 11-07-2012
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Arrow Gyrus Daily Questions; Internal Medicine #74

A 60-year-old man conies to the emergency department because of a 2-day history of severe abdominal pain He denies nausea, vomiting, or diarrhea He does not drink alcohol or smoke cigarettes He has not traveled outside of the country and has no sick household contacts Examination shows mild jaundice The liver has a span of 14 cm and is tender and smooth Laboratory studies show

Hemoglobin 20.1
Hematocrit 63%
Leukocyte count 11.8001mm 3
Platelet count 476.000/mm 3

Serum studies show:
Aspartate aminotransferase (AST GOT) 412 U/L
Alanine aminotransferase (ALT. GPT) 622 UIL

Peripheral smear shows normal-appearing morphology of the cells. Which of the following is the most likely diagnosis?

A. Alcoholic cirrhosis
B. Budd-Chian syndrome
C. Cholelithiasis
D. Chronic hepatitis
E. Fulminant hepatitis A
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B...budd chiari syndrome........sudden onset, erythrocytosis, thrombocytosis....may be polycythemia vera
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Share with u same idea-- Anomali
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Answer is B Bud chiari syndrome.

This patient has signs and symptoms of Budd-Chiari syndrome. a rare disorder with high mortality rate usually caused by the thrombosis of major hepatic veins It can present either acutely. as in this case. or more slowly with chronic vague abdominal pain and portal hypertension (presenting with ascites or splenomegaly) This patient's elevation in all cell lines, especially the red blood cell line, indicates that this patient has polycythemia vera. a myeloproliferafive disorder that predisposes patients to Sudd-Chiari syndrome. Approximately a quarter of individuals who have Budd-Chiari have an overt myeloproliferafive disorder at presentation. like this patient Other underlying predisposing causes include hematologic disorders (sickle cell disease, paroxysmal nocturnal hemoglobinuria). defective inhibition of coagulation (anfiphospholipid antibodies. low anfithrombin III. low protein C. low protein S. and low factor V Leiden). possibly estrogens (oral contraceptives, pregnancy); and local liver disease (malignancies, trauma, or suppurative lesions). Alcoholic cirrhosis (choice A) can cause jaundice. but AST and ALT elevations are usually not very high. Furthermore nothing in this man's history suggests significant alcohol use Cholelithiasis (choice C) can cause obstructive jaundice when a small stone occludes a bile duct. but AST and ALT elevations are usually not very high flo risk factors are noted for either chronic hepatitis 6 (choice D) such as unprotected intercourse or IV drug use. Chronic viral hepatitis does not usually have very high elevations of AST or ALT.
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Quote:
Originally Posted by anomali View Post
B...budd chiari syndrome........sudden onset, erythrocytosis, thrombocytosis....may be polycythemia vera
Very very good anomali..............you are rolling.
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Quote:
Originally Posted by Novobiocin View Post
Very very good anomali..............you are rolling.

can't match u Novo.............you are an asset to this forum...
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