Clinical situation 1

Patient, 50 years old, man has pains in right hypocondrium with irradiation in back and right scapula, low appetite, weakness also nausea, vomiting and skin itch.

Blood test:

Hb –135 g/l

Total protein – 65 g/l

Total cholesterol – 12 mcmol/l

Bilirubin total – 100 mcmol/l

Unconjugated – 19 mcmol/l

Conjugated – 81 mcmol/l

Rest nitrogen – 23 mmol/l

Urine test:

Diuresis – 1200 ml

Color – brown

Transparency – transparent

Glucose-negative

Protein- negative

Urobilin - negative test

Specific gravity of urine – 1.020

What are the changes in blood and urine test?

Which metabolic processes are damaged?

With which pathological conditions it may be?

What is it mechanism of this malfunctions.

Clinical situation 2

Mother of 8 year old of his child had nausea and vomiting two times, temperature 37-38 C. On examination child was weak, light yellow sclera’s, pains of abdomen and where the pains in right epigasticall

Blood test.

Erythrocyte sedimantation rate (E.S.R)-32 mm/l

Leucocytes – 12,5 * 10 ⁹ g/l

Bilirubin total – 34,5 mcmol/l

Indirect – 18,0 mcmol/l

Direct – 16, 5 mcmol/l

LDH – 8,5 mcmol/l * ml

ALT – 580 nmol/l/h (1,68 mcmol/l)

Glucose –4,5 mmol/l

Hb - 135 gr/l

Total cholesterol – 5,1 mmol/l

Urine test:

Diuresis – 1,200 ml

Color – dark yellow

Transparency – transparent

Specific gravity of urine – 1,020

pH weak acidic

bile pigment – positive test

What are the changes in blood and urine test?

Which metabolic processes are damaged?

With which pathological it may be?

What is the mechanism of this malfunctions?

Clinical situation 3

A man, 47 years old complains on the weakness, progressive deterioration (impairment), meteorism, appetite loss (anorexia) bitter taste in the mouth, loss of weight, nousea, vomiting, periodical increase of the temperature, and skin itch, the urine is cloudy and dark. About 10 years man abuses of alcohol.

Blood test:

Total protein – 45 gr/l (hypoalbuminemia and hyperglobulinemia)

Urea – 0,5 mmol/l

Total bilirubin – 85 mcmol/l

Indirect – 64 mcmol/l, direct – 21

Lipoproteins – 1,5 gr/l

Total cholesterol – 1,5 mmol/l

Coagulation test – Veltman test - upheaval right

Hb – 80 gr/l

Total LDH – 9,5 mcmol/h/l

ALT - 540 nmol/ls/ (normal - 30-420 )

Urine test:

Diuresis – 1,100 ml

Color – brown

Transparence – transparent

Specific gravity – 1,012

pH – slightly acidic

Bile pigments – positive

Glucose – no (absent)

Protein – no (absent )

What organ is damaged in this pathological condition?

In which pathological condition may be these changes?

Preliminary diagnosis the mechanism of theirs development?

Clinical situation 4

Woman 19 years old complains on the pain in the abdomen, headache, are appeared the black spots in front of eyes, periodically arising the jaundice of skin, very dark urine (especially in the morning), transient weakness.

Blood test:

Total protein – 50 gr.

Glucose – 4,5 mmol/l

Total bilirubin – 120 mcmol/l

Indirect – 95 mcmol/l, direct – 25

Ketone bodies – 500 mcmol/l

Lipoproteins – 4,0 gr/l

Total cholesterol – 5,7 mmol/l

Erythrocytes – 2,10 x 10¹² gr/l

Leukocytes – 4,7 x 10⁹ gr/l

Erythrocytes sedimentation rate – 10 mm/h

Hb – 64 gr/l

ALT – 90 nmol/l (N 30- 420 nmol/l)

Urine test:

Diuresis – 1,500 ml

Color – yellow

Transparency – transparent

Specific gravity – 1,020

pH – slightly acidic

Urobilin – acute positive

Bile pigments – negative

Glucose – no (absent)

What are the changes in blood and urine tests?

Which metabolic processes are damaged?

With which pathological it may be?

What is the mechanism of this malfunctions?

Answer 1

These changes are developed due to damage of liver. Preliminary diagnosis: cirrhosis. In the blood test are hypohemoglobinemia, hypocholesterolemia hypoproteinemia (hypoalbuminemia). Is increase a urea content and lipoproteins. Is increased the activity of enzymes (LDH, ALT). Urine test- color is dark, are appeared bile changes pigments due to degenerative changes in the liver, and due to damage of hepotocytes. As a result of degradation of hepatocytes the enzymes enter into the blood stream, this leads to considerable damage of liver functions. Cirrhosis of liver (acute and chronic hepatitis) is one of reason of hepatic coma development.

Answer 2

These changes are appeared in the blood - the increase of erythrocyte sedimentation rate, the increase of enzymes activity (LDH and ALT), is increased the total billirubin content, in the urine is appeared billirubin (billirubinuria). These changes happen as a result of acute hepatitis (acute damage of hepatocytes). Preliminary diagnosis - viral hepatitis (Botkin’s disease). At viral hepatitis are damaged the hepatocytes so, is decreased the bile production, as a result of damage of liver parenchyma , the bile enters not only into the bile duct, bile is appeared in the blood so, in the blood is increased the concentration of unconjugated (indirect) billirubin and conjugated (direct) billirubin. Through kidneys the billirubin (conjugated) passes into the urine and is defined in the urine.

Answer 3