archer q422 ...awesome question! - sadhan

[ArchivalUser]

cccc

[ArchivalUser]

good explanation sadhan,,,i was going with b though,,step 3 is scary

[ArchivalUser]

DDD

[ArchivalUser]

it shud be C. pt doesn c/o anything presently. PE is normal vitals normal.

[ArchivalUser]

well whats harm in ct with epigastric pain, elevated enzyme, though pt already had dialysis session so the enzyms should be normal value

[ArchivalUser]

Correct answer is C like explained by sadhan.
-this pt is PAIN Free and just undergoing office visit
- ALK phos are barely high if not WNL >> so any type of obsturction is out ( it cannot be gallstone pancreatitis then even if it was acute pain)
- T bili is barely high if not nle>> there is no cholestasis
- Dx of acute pancreatitis is clinical + elevated lipase and amylase. you do CT scan to rule out complications ( ask me how many physicians do the Ransom score now...)

So option A is false unless you want tu rule out acute cholecystitis as a DDx of epigastric pain. If you want to check for stones, the clinical picture does not fit for the reason I mentioned above.

B is not possible: unless you want to hospitalize pt for " no reason"

D you do it if you suspect obstruction (ALl phos will be very high)

E: I explained above

[ArchivalUser]

This is a simple approach when you get LFTs:

Obstruction pattern: Elevated ALK phos, mildly elevation of AST, ALT
inflammation pattern: Elevated AST, ALT, mildly elevation of alk phos. if AST, ALT >1000, suspect ischemic liver or drugs or hepatitis.
Cholestasis: elevated bilirubin. If predominantly direct >>obstruction. if predominantly indirect >> inflammation/hemolysis
Pancreatitis: elevated lipase (more specific) an amylase with clinical picture

[ArchivalUser]

awesome it is.

[ArchivalUser]

good q, answer obvious C

[ArchivalUser]

very nice q ...thanks sadhan!