Question

A 56 year old white male who is self-admittedly an alcoholic arrives to the ER with a 2 week history of mid-abdominal pain, nausea/vomiting with a 10 lb weight loss. He also describes that his bowel movements are 'not normal' they are clay-colored. Attending physician notes mild jaundice and orders the following labs:

Total Bilirubin (0.3-1.0 mg/dL)	4.2 mg/dL
LDH (0-200 IU/L)	625 IU/L
ALT (0-46 IU/L)	76 IU/L
ALP (0-80 IU/L)	462 IU/L
Amylase (0-85 IU/L)	80 IU/L
Urine Bilirubin (negative)	3+

Questions:

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 an accurate diagnosis?

4. What other studies or procedures might be required?

Answer 1

1. The organ system primarily involved is the digestive or gastrointestinal system.

2. Major diagnostic considerations- Liver damage from hepatitis, cirrhosis or infection, liver cancer.

3. Meaning of the laboratory results: Increased levels of bilirubin, LDH, ALT, ALP and urine bilirubin indicate towards liver diseases. Additional tests to establish accurate diagnosis: AFP test to rule out liver cancer.

4. Other studies or procedures:CT,MRI,USG, Liver biopsy.