Question

NURS-60506: GI Case Study A 32 yr old female presented to your office complaining of abdominal pain. She states this pain started yesterday and increased over the course of a couple of hours. It is mostly in the epigastric region and does radiate at times to the RUQ. She states it has been constant since then, Currently rates it at a 7/10. She has never had pain like this before. Denies any vomiting but does complain of nausea. She denies any diarrhea or constipation. Denies any documented fevers but has felt a little chilled this am. Denies any abdominal bloating. She does state she drinks a glass of wine each evening. Denies any tobacco use or street drug use. Current labs WBC 13.2 Hgb 14.0 Hct 38.9 Plt 250 Na 142 K 4.0 BUN 26 CR 1.2 Total bilirubin 2.5 mg/dl AST 289 ALT 302 Alk Phos 358

Answer 1

1. differential diagnosis

a. HEPATITIS (SUB ACUTE)

The patient is complaining about abdominal pain which is not so severe and constant after the occurence. she is also having elevated AST and ALT value along with elevated bilirubin level. she is also having elevated wbc which indicates infection. she is also having low hematocrit value. since is daily takes alcohol content hasn't affected the liver. the ast to alt ratio is normal

b. CHOLICYSTITIS OR CHOLILITHIASIS

both the are associated with moderate to severe pain and vomiting. this conditions show pain radiating to back. it will have elevated liver enzymes.

c. PANCREATITIS

here the character of pain is severe and radiating to back associated with vomiting

2. ADDITIONAL LAB INVESTIGATIONS  

serology and viral markers

3. FURTHER DIAGNOSIS

a. blood sample for HEPATITIS A,B,C,G AND E

b. serum amylase and serum lipase : to rule out pancreatitis

c. USG abdomen

d. CECT abdomen if USG is doubtful

4. Asparate Aminotransferase (AST )or Serum glutamic oxaloacetic transaminase (SGOT) normal value is 5 to 40 U/L and Alanine transaminase( ALP) or Serum glutamic pyruvic transaminase (SGPT) normal value is 7 to 56 U/L

the ratio for this patient is less than 1

5. if the ratio was greater than 1 it indicates the patient is having alcoholic liver diseases

the normal ratio is 0.8