Case study part 1
1. What is the probable disease?
2. What is the cause for the low serum calcium?
3. What is the cause for the increased blood urea nitrogen?
Case study part 2
1. What organ system is primarily involved?
2. What are the major diagnostic considerations?
3. What do the laboratory results mean? What additional laboratory tests would be useful in establishing a diagnosis?
4. What other studies or procedures might be required?
Case study part 1
1. In the above case study, the man is probably suffering from kidney abnormalities or acute pancreatitis secondary to gallstones or liver abnormalities as he has a previous history of mild liver abnormalities and heavy alcohol consumption. The patient lab result indicates amylase 640 units, which is high and indicates pancreatitis. The other parameters like the patient’s low blood pressure 80/40 mm Hg and fast pulse rate at 110/min. The patient has high BUN, low potassium levels at 3.4 mmol/L, and low sodium level at 133 mmol/L which may indicate kidney disorder/liver disorders. He also has WBC at 16, 500/uL which is indicative of inflammation.
2. The cause of low serum calcium level is may be due to chronic alcoholism as the patient has 15 years of history of alcoholism, or kidney abnormalities, and inability to absorb fat, which is essential for vitamin D and calcium absorption. Chronic alcohol consumption results in liver damage which further malfunction the conversion of vitamin D to calcium ("AKT answer relating to causes of abdominal pain in alcohol dependence", 2010).
3. The patient has a high level of blood urea nitrogen 32 mg/dL which may have caused due to excessive protein catabolism, kidney abnormalities/liver abnormalities as the production of urea initially start in the liver then it is released in the kidney, and it indicates malfunctioning of liver. It may also be the result of pancreatitis, dehydration, or renal malfunction. BUN testing is the part of CMP or BMP reveals a chemical imbalance in the patient.
Case study part 2
1. In the above case study the patient‘s digestive system was primarily involved in the present symptoms of the patient and the organs are liver and pancreas. His symptoms such as the 2-week history of mid-abdominal pain, clay-colored stools, nausea, mild icterus, vomiting and weight loss indicate that the patient is suffering from acute pancreatitis and liver disease.
2. The major diagnostic consideration for the diagnosis of the patient’s mid-abdominal pain are: the physical exam of the patient, ultrasound, biopsy, enteroscopy, glucose tolerance test, computed tomography, MRI imaging technique to find the location of abnormalities, and laboratory tests including blood count and pancreas and liver enzymes. ERCP (endoscopic retrograde cholangiopancreatogram) is used to detect bile duct abnormalities and help in the removal of gallstones in the patient (Kitagawa, 2007).
3. Laboratory tests help detect the reason of the mid-abdominal pain occasionally. The laboratory results shown in the above case study signifies liver abnormalities such as patient’s liver damage reflected by elevated levels of bilirubin 4.2 mg/dL, LDH 625 IU/L, ALT 76 IU/L, ALP 462 IU/L, and urine bilirubin. The increased levels of amylase and LDH indicate pancreas or damage to the pancreas also. The additional laboratory tests for establishing the diagnosis of the patient, appropriately without any deviation or false results are serum lipase test, complete blood count, stool analysis, albumin test for liver function, secretin stimulation test for pancreas function, the test of fecal elastase and comprehensive metabolic panel.
4. The other studies and procedures required for the patient’s symptom are an ultrasound (a non-invasive method useful in the detection of mid-abdominal pain causes, biopsy, computed tomography (CT), which helps to record the multiple x-rays images of the body and radiology tests to detect the abnormalities in the digestive system or abdomen. There is various type of enteroscopy methods which is used to diagnose the abnormalities inside the gastrointestinal tract. The most less invasive technique for the patient would be a pill, which can be easily swallowed and the images of the gastrointestinal tract is observed for further evaluation.
AKT answer relating to causes of abdominal pain in alcohol dependence. (2010).Innovait, 3(3), 187-187. https://dx.doi.org/10.1093/innovait/inq014
Kitagawa, M. (2007). Current Concept For Diagnosis Of Acute Pancreatitis. Pancreas, 35(1), 88. https://dx.doi.org/10.1097/01.mpa.0000278680.32942.9e