Hello friends, here's a question I am struggling with.
A 24-year-old man is evaluated for a 6-day history of malaise, fatigue, and jaundice following a
camping trip in rural Mexico 3 weeks ago. His alcohol consumption is approximately 6 beers per
week, never exceeding more than 2 beers per occasion. Two weeks ago he participated in a marathon
race and finished the race without incident. His sister was recently diagnosed with primary biliary
cirrhosis. The remainder of his history is unremarkable.
On examination, temperature is 37.8°C (100.0°F), blood pressure is 132/72 mm Hg, pulse rate is
104/min, and the respiration rate is 16/min. BMI is 21. Examination shows sclera icterus and
hepatomegaly. The remainder of the examination findings are normal.
Bilirubin (total) 4.6 mg/dL (78.7 μmol/L)
Bilirubin (direct) 3.5 mg/dL (59.9 μmol/L)
Aspartate aminotransferase 1123 U/L
Alanine aminotransferase 1350 U/L
Alkaline phosphatase 185 U/L
(A) Cholestatic injury
(B) Hepatocellular injury
(C) Mixed hepatocellular and cholestatic injury
(D) Nonhepatic injury pattern (muscle injury)
I answered C because the labs suggests intrahepatic injury and the alk phos elevation suggest biliary injury. The answer is B. Is this just because the alk phos isn't elevated high enough which means that biliary injury is an unlikely finding?
A 24-year-old man is evaluated for a 6-day history of malaise, fatigue, and jaundice following a
camping trip in rural Mexico 3 weeks ago. His alcohol consumption is approximately 6 beers per
week, never exceeding more than 2 beers per occasion. Two weeks ago he participated in a marathon
race and finished the race without incident. His sister was recently diagnosed with primary biliary
cirrhosis. The remainder of his history is unremarkable.
On examination, temperature is 37.8°C (100.0°F), blood pressure is 132/72 mm Hg, pulse rate is
104/min, and the respiration rate is 16/min. BMI is 21. Examination shows sclera icterus and
hepatomegaly. The remainder of the examination findings are normal.
Bilirubin (total) 4.6 mg/dL (78.7 μmol/L)
Bilirubin (direct) 3.5 mg/dL (59.9 μmol/L)
Aspartate aminotransferase 1123 U/L
Alanine aminotransferase 1350 U/L
Alkaline phosphatase 185 U/L
(A) Cholestatic injury
(B) Hepatocellular injury
(C) Mixed hepatocellular and cholestatic injury
(D) Nonhepatic injury pattern (muscle injury)
I answered C because the labs suggests intrahepatic injury and the alk phos elevation suggest biliary injury. The answer is B. Is this just because the alk phos isn't elevated high enough which means that biliary injury is an unlikely finding?
