q4 - natasha15

[ArchivalUser]

A 23-year-old Caucasian woman complains of mild jaundice and fatigue. Upon further questioning, she reports having dark urine and light-colored bowel movements. These symptoms have occurred intermittently for at least the last 6 months and seem to have become worse recently. Her past medical history is significant for a history of idiopathic thrombocytopenic purpura as a child, as well as a distant history of thyroiditis. Vital signs are: blood pressure 132/78 mm Hg, pulse 78/min, respirations 20/min, and temperature 37.C (98.6 F). Physical examination reveals mild hepatosplenomegaly, but no other signs or stigmata of liver disease. Laboratory studies show:



Viral hepatitis serologies are negative. An antinuclear antibody (ANA) assay is positive with a titer of 1:360 in a speckled pattern. Antimitochondiral antibodies (AMA) are negative. Anti“smooth muscle antibodies (ASMA) are positive. Which of the following is the most appropriate treatment for this patient?
A. Clofibrate
B. Methotrexate
C. Penicillamine
D. Prednisone
E. Ursodeoxycholic acid

[ArchivalUser]

lab studies???????

[ArchivalUser]

D....

[ArchivalUser]

dddddddddd for AutoImmune Hep
and eeeee for PBC and PSC

[ArchivalUser]

The correct answer is D. This patient has autoimmune hepatitis. Type I autoimmune hepatitis is the classic form of the disease, and is characterized by female predominance, extrahepatic autoimmune disease (in this case thyroid and ITP), hypergammaglobulinemia (evidenced by the high total protein/albumin ratio), and a positive ANA and ASMA. This disease usually responds to low-dose steroids, or a combination of steroid and azathioprine.

Clofibrate (choice A) is used in the treatment of hypercholesterolemia and has no role in treating autoimmune hepatitis.

Methotrexate (choice B) has had some success in small studies. However, it is not considered a first-line agent in the treatment of autoimmune hepatitis, which often responds favorably to low-dose steroids and/or azathioprine.

Penicillamine (choice C) is used to treat Wilson disease. It has not been found to be effective in PBC.

Ursodeoxycholic acid (choice E) has been shown to delay progression of primary biliary cirrhosis but has no effect on autoimmune hepatitis.

[ArchivalUser]

dd

[ArchivalUser]

ee?? like u said in ither question, bile duct stones due to lupus hemolytic symptoms?

[ArchivalUser]

Thanks Natasha!