Question

Urgent!Based on the information provided may you please help me to provide the best answer possible. Thank you so much!!!

After 4 years of Medical school, you start your Internal Medicine residency at Princeton- Plainsboro Teaching Hospital (PPTH) under the guidance of Dr. Gregory House. Dr. House arrives and said Woman, 33 years old,is in ER and she refers epigastric pain with nauseas, postprandial Cam- vomiting and asthenia. Two weeks ago an antibiotic for odynophagia (erythromycin) was prescribed, however she left the treatment after 9 days She does not have fever although she describes dystermia symptoms. Initial physical examination of the patient indicated a soft, depressible abdomen with epigastric and right hypochondrium pain on palpation. Mucocutaneous jaundice. No family history of liver diseases She suffered anxious syndrome and bulimia during childhood. No drug or other prescription medicine. ER performed an abdominal ultrasound, suggested acute cholecystitis with slightly enlarged liver. Based on these findings, ER carried out an open cholecystectomy and direct cholangiogram. It didn't show any alterations. Anatomopathological examination reported cholestasis and chronic liver disease pre- cirrhosis. The results of laboratory tests (blood are urine):

Answer 1

Heavy metal toxicity could be the reason for the patient signs and symptoms.

High level serum copper, urine copper and hepatic copper are suggestive of copper toxicity. Copper toxicity is defined as increased levels of copper in the body due to high levels of copper ingested.

Copper toxicity also affects the liver. High level of copper are deposited in the liver causing hepatic impairment.   

Copper toxicity causes renal impairment, neurological symptoms, muscle weakness, gastrointestinal distress.