Questions to prepare for classes and examination
• General causes and mechanisms of the liver dysfunction.
• The syndrome of hepatic insufficiency. Typical disorders of carbohydrate, amino acid, protein, and lipid metabolism in hepatic insufficiency; failure of detoxification function.
• Causes, types and pathogenesis of hepatic coma.
• Hemolytic jaundice: causes, mechanisms, clinical and laboratory manifestations.
• Obstructive jaundice: types, causes, mechanisms, clinical and laboratory manifestations, consequences.
• Hepatocellular jaundice: causes, mechanisms, stages, clinical and laboratory manifestations.
• Primary enzymopathic jaundices: etiopathogenesis and manifestations of the Gilbert's, Crigler-Najar's, and Dubbin-Johnson's syndromes.
N 115
A 46-year-old patient B. has visited his physician with complaints of right upper quadrant tenderness, nausea, vomiting, weakness, fatigability. In the patient's history there is an episode of jaundice at the age of seven. On examination: the skin and conjunctiva appear jaundiced; blood pressure 110/75 mm Hg, heart rate 86 per minute; the liver is enlarged and nontender on palpation; the spleen is significantly enlarged; the stool is normally colored; the urine is dark. Blood test data: Hb 72 g/L, erythrocyte count 3.0x1012/L, reticulocytes 11%, leukocyte count 3.7x109/L, white blood cell count differential is unremarkable; ESR - 9 mm/h.
Microscopy of the blood smear demonstrates anisocytosis, poikilocytosis, and spherocytosis of erythrocytes. Osmotic fragility test shows an increased hemolysis. Blood biochemistry data: total protein 60 g/L (N: 70-80 g/L), total bilirubin 5.8 mg/dl (N <1.3 mg/dl), conjugated bilirubin 0.15 mg/ dl (N <0.30 mg/dl), urobilinogen is detected; serum AST activity 52 U/L (N <38 U/L); glucose level 75 mg/dl. Urine test data: 24-h urine volume 1.450 ml, specific gravity 1028, protein and glucose are not detected; positive reaction for Hb.