A 60-year-old man with a history of alcoholism is seen in an urgent care clinic; he...
A 60-year-old man with a history of alcoholism is seen in an urgent care clinic; he complains of extreme pain in his upper abdomen. He has been experiencing pain on and off for the past 10 days. Now he is yellow (jaundice) and feels extremely ill. He also mentions that his stool specimens have lost their normal color and look like clay. Blood is drawn for testing and urine collected for urinalysis. The following urinalysis results were obtained:
Physical Appearance
Color: Brown (yellow-brown)
Transparency: Clear . Foam: Abundant yellow foam
Chemical Screening
pH: 6.5 . Specific gravity: 1.020
Protein (reagent strip): Negative . Blood: Negative
Nitrite: Negative . Leukocyte esterase: Negative
Glucose: Negative . Ketones: Negative
Bilirubin: Large . Urobilinogen: Normal
Microscopic Examination
Red blood cells: 0-2 per hpf White blood cells: 0-2 per hpf
Questions
1. The abnormal urine color is caused by which of the following?
a. Bilirubin
b. Free bilirubin
c. Unconjugated bilirubin
d. Urobilinogen
e. More than one of the above
2. The lack of color in the feces is caused by an absence of which of the following?
a. Bilirubin glucuronide
b. Free bilirubin
c. Unconjugated bilirubin
d. Urobilinogen
3. This patient’s jaundice is the result of the presence of which of the following?
a. Bilirubin glucuronide
b. Unconjugated bilirubin
c. Urobilinogen
d. More than one of the above
4. From the patient history and the urinalysis, this patient’s jaundice is probably the result of which of the following?
a. Acute alcoholism leading to a cirrhotic liver
b. Hemolytic jaundice
c. Infectious hepatitis
d. Obstructive jaundice associated with gallstones
Homework Answers
1. Abnormal urine colour is because of presence of bilirubin in urine.
2. The lack of colour in feces is due to absence of bilirubin in stool.
3. Unconjugated bilirubin causes jaundice as conjugated bilirubin is excreted normally.
4. Acute alcoholic leading to cirrhotic liver disease that causes jaundice as alcohol is metabolised in liver.
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