Case Report C

(Laboratory interpretation report)

Name of clinician (student): _________________________________ Date: 2007 01 29.

Patient’s name: Anne Zioty

A 50-year-old administrative assistant has had increasing jaundice for a month now.
For the last three months she has had poor appetite and has lost 7 kg in weight.
She notices that her urine was darker in colour than usual and her feces were pale during
the last month.

Additional information needed:

Temperature 36.8oC
Pulse 64 beats/minute
Blood pressure 120/70
Respiration rate 24/minute.
No abdominal pain
No fever

Medical history: Depression and anxiety.

Mental illness since the age of 30. Once overdosed on barbiturates. Treated with a lot of
different drugs. The last few months she has been treated with phenelzine and
trifluoperazine for agitated depression

She smokes 30 cigarettes a day

Bouts of heavy drinking.

Jaundiced,
Underweight
Skin showed scratch marks on her trunk and several bruises on the arms and legs.
No lymph nodes palpable.
Respiratory, cardiovascular and central nervous system CNS were normal
Liver felt 2 cm below the right costal margin.
Spleen and gall bladder could not be felt
No ascites.
Relevant laboratory results:

Differential dx Test Result Healthy range Interpretation

Cholestasis ALT 65 U/L 3-35 Cholestasis
gallstones ALP 800 U/L 3-100
GGT 150 U/L 5-50
PT 20 seconds 11-15 seconds

Metastatic CEA 7 <5 4% of smokers

cancer CA 15.3 10 <15.5 kAU/L breast cancer? 0
Hepatoma AFP 15 ug/L <8.5 ug/L Not likely
Carcinoma of 5 HIAA Not done <130 umol/d
bile duct
Carcinoma CA 19-9 1,130 kAU/L < 40 kAU/L Pancreatic
head of the cancer
pancreas
Drug induced Stopping drug, Not done.
cholestasis
Viral hepatitis Anti-HA (IgM) Negative Negative No viral
HBsAg hepatitis A or B
PBC Mitochondrial Negative Negative No PBC
Autoimmune Mitochondrial Negative Negative No autoimmune
hepatitis Antibodies
Underline working diagnosis.
Comments:
Hepatoma usually preceded by cirrhosis.
History not like gall stones.
Patient is alcoholic but no stigmata to suggest cirrhosis
Further diagnostic test(s) required and why.
Carcinoma of bile duct is rare but looks like carcinoma head of the pancreas.
Phenelzine causes hepatocytic jaundice. (MAO inhibitor)
Trifluoperazine may cause cholestasis. (Phenothiazine)
Primary biliary cirrhosis: middle aged women, intense pruritis, xanthomata of skin and
tendons, pigmentation of skin as well as jaundice.

Chest X ray for bronchial carcinoma, bone secondaries.

Ultrasound or CAT scanning of the liver, pancreas and biliary tree.
Contrast radiology by ECRP or transhepatic percutaeous cholangiography
Laparotomy

How should she be treated?

Surgery.
Palliative stent
Removal.