Question

A 25 years’ girl who was involved in sexual activity years ago comes to the clinic with distended abdomen complains of fatigue, abdominal pain and loss of appetite. On physical examination, the patient had yellowish skin and yellowish eyes. Laboratory macroscopic examination of stool and urine shows pale stool and dark urine. The pregnant test was negative.

a. Discus the possible pathophysiology involved in:

I. Skin and eyes changes to yellow in this patient. 15 marks

II. Pale stool and dark urine 15 marks

b. Discus and justify your possible diagnosis using information provided in this question 10 marks

c. To confirm your diagnosis, list and justify for each Laboratory tests you would request and state reasons why. 10 marks

Answer 1

a. Possible Pathophysiology

I. Usually, the bilirubin is formed when Hb is broken down after the damage of red blood cells for the recycling process. This bilirubin is carried into the liver and binds with bile. Then it entered into the digestive tract and eliminated via feces. But sometimes, the bilirubin cannot move through bile ducts and get deposited in the skin results in changing of yellowish skin. Too much of bilirubin pigment in the blood discolorate white eyes into yellow eyes.

II. When bile duct causes blockage and prevents eliminating of bilirubin through the digestive tract results in the pale-colored stool. Then this accumulated bilirubin eliminated excessively through urine results in dark-colored urine.

b. Possible Diagnosis:

The possible diagnosis for this patient is Jaundice. Because of the symptoms of fatigue, abdominal pain, loss of appetite is related to the symptom of Jaundice. The physical examination of yellowish eyes, yellowish skin and macroscopic examination of dark urine and pale stool also proves that the patient is suffering from Jaundice.

C. Laboratory test to confirm the diagnosis:

• Complete blood count to know the level of Red blood cells.
• Serum bilirubin test to know the bilirubin level.
• Ultrasonography to detect the structure of the liver.
• Liver biopsy to know the function of the liver.