01/19/2007

Case 1: Matthew

Case 2: Austine

Case 2 follow up: Frankie

Bilirubin Metabolism: Sara

Classification of Jaundice: Linda

1. Identify salient historical information that my have a bearing to this patient's chief complaint and indicate its significance.

2. What is your working diagnosis for her Jaundice based on the history.

3. Identify salient physical findings that my have a bearing to this patient's chief complaint and indicate its significance.

4. What is your working diagnosis for her Jaundice based on the history and physical?

5. Identify salient Laboratory findings that my have a bearing to this patient's chief complaint and indicate its significance.

6. Cite the main clinical problem (not the diagnosis) 

7. Cite other significant clinical problems (not diagnoses). 

8. We need a clear understanding of Bilirubin metabolism to solve clinical problems related to it Briefly review the formation of bilirubin. 

9. Discuss a differential diagnosis based on disease categories. A good way to discuss this question is to approach the jaundiced patient according to the fractionation of the bilirubin. 

10. How do you Classify jaundice 

11. Now after listing differential diagnosis, what are the important historical information you should gather from history and why?

12. Now after listing differential diagnosis, what are the important physical findings you should gather from physical examination and why?

13. What are the useful lab studies in evaluation of a patient with jaundice and their utility?

14. What patho-physiologic process does the laboratory data suggest?

15. What is the diagnosis in this patient

5.      16. Cite data from the history, physical exam and laboratory to support this diagnosis.

17. What other laboratory/radiologic examinations might be done to exclude other causes of jaundice? 

7.      18. Assuming that she has alcoholic hepatitis what would a liver biopsy show in this patient?

19. What advice would you give the patient regarding the use of Tylenol.

 Case 2

1. Identify salient historical information that my have a bearing to this patient's chief complaint. Elaborate on the significance of each.

He has two stages to his illness one following surgery and another 4 years later

2. List salient findings in his first ER visit Elaborate on the significance of each.

3. List salient findings in his second  ER visit in 2 months Elaborate on the significance of each.

4. What is Gilbert’s syndrome?  What would the  fractionation  of bilirubin show in patients with Gilbert’s?

5. Explain the pathophysiology behind Gilbert’s syndrome.

6. Is Gilbert’s syndrome associated with disease?  What harm can result from chronically elevated Bilirubin?

7. What is the most likely etiology for his Jaundice in post op hospitalization period?

8. During the patient’s pot-op hospitalization, what additional tests should be performed?

9. What is the significance of the ultrasound findings?

10. What is sludge?  

11. What is the significance of the history of Gilbert's disease. Is it a factor in his Jaundice?

12. Discuss a differential diagnosis for this patient when he visits the ER 4 years later for the first time.

13. What additional tests would you do as a result of this first ER visit?

14.  Discuss the laboratory result obtained during the second ER visit.

15. What comments would you make regarding the rapid weight loss liquid protein diet?

16. What definitive recommendations would you make for this patient at this time?