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+--- Thread: GI q - eb2222 (/showthread.php?tid=231024)
GI q - eb2222 - ArchivalUser - 10-13-2007
A 67-year-old woman who has previously been healthy undergoes emergency surgery for a ruptured abdominal aortic aneurysm. Intraoperatively she requires 8 units of packed red blood cells to maintain her blood pressure and hematocrit. After surgery she is hemodynamically stable. On the third postoperative day she appears jaundiced, but abdominal examination is unremarkable and she is afebrile. Total serum bilirubin concentration at this time is 141 mol/L (8.3 mg/dL) [direct, 107 mol/L (6.3 mg/dL)]. Serum alkaline phosphatase level is 6 kat/ L (360 U/L), and serum AST level is 0.85 kat/L (51 Karmen units/mL). The most likely explanation for the woman™s jaundice is
(A) a stone in the common bile duct
(B) halothane hepatitis
© posttransfusion hepatitis
(D) acute hepatic infarct
(E) benign intrahepatic cholestasis
0 - ArchivalUser - 10-13-2007
C.
0 - ArchivalUser - 10-13-2007
b....
0 - ArchivalUser - 10-13-2007
answer is acute hepatic infract which gives simlar pic ---cong. hyperbilirubinemia moderately elevatd aminotransferases-- no fever
halothane is no longer used for its hepato-toxicity
postransfusional hepatits- duration too short
D is familal disease which is recurrent
cannot be stone
0 - ArchivalUser - 10-13-2007
EEEE
Serum alkaline phosphatase level is 6 kat/ L (360 U/L), is high
serum AST level is 0.85 kat/L (51 Karmen units/mL are normal.... pt has no ruq tenderness, fever r/o a,b,d
post tranfusion hep occur after period of 8 weeks
benign postop intrahepatic cholestatis is seen after major sx asso with complications such as excessive bleeding leading to the need of blood transfusion.. the factors cotributing to jaudice which occurs usually on the 2nd or 3rd post op day are excessive pigemt load due to tranfusion and liver ischemia which dec liver function and renal ischemia which causes dec excretion of bilirubin
0 - ArchivalUser - 10-13-2007
The liver is difficult to infarct because of its dual blood supply
0 - ArchivalUser - 10-13-2007
Infarct
Blockage of intra-hepatic blood vessels by tumor or vasculitis can result in infarcts of the liver.
Another important cause of hepatic infarcts is sickle cell disease.
Pathogenesis
¢Blockage of arterial blood flow results in anoxic cell injury and the development of an infarct.
¢Blockage of the portal vein does not usually result in an infarct because the portal artery continues to provide the liver cells with oxygen,
Epidemiology
¢Liver infarcts are rare because of the dual blood supply.
General Gross Description
¢Blockage of the intrahepatic artery can result in typical wedge shaped pale infarcts.
¢Occlusion of the portal vein does not result in an infarct because of the hepatic arterial blood supply.
¢However, an area of mottled discoloration may be seen, referred to as an infarct of Zahn.
General Microscopic Description
¢Infarcts due to occlusion of the hepatic artery are characterized by coagulative necrosis of the liver cells, followed by infiltration by inflammatory cells, resorption of tissue and the development of a scar.
Clinical Correlation
¢May present as pain the upper right quadrant.
0 - ArchivalUser - 10-14-2007
may i know the refrence. I think ans id D as it can be caused by conditions such as shock and hypovolemia. RQP is not necessary. In your question u have mentioned the patient has been healthy previously. E tends to have recurrences and tends to be familial