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GI case #3


GI case #3


حالة سريرية

الوصف الكامل Background
A 21 year old female college student has a 1 week history of malaise, anorexia, nausea, and vomiting. Three weeks ago, she returned from Guatemala, where she had engaged in missionary work.
On physical examination, temperature is 37.9 C. there is mild jaundice and a palpable, tender liver.
Labs:

Hematocrit 48%
WBC 9000
INR 1
Alk phos 110
AST 1100
ALT 1700
Total bilirubin 3

Which of the following laboratory tests is most likely to establish the diagnosis?
A) Anti HBs Ag
B) Anti HCV
C)Indirect hemagglutination test for Entamoeba histolytica
D) IgM anti HAV
E) EBV DNA

Hot sauce's picture
by
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D) IgM anti HAV
I suspect Viral Hepatitis A, she should had had the vaccine b4 she got to guatemala.

DAM's picture
DAM


Answer D

Dr_Ayyad
بعد التخرج

Quote:
A 21 year old female college student has a 1 week history of malaise, anorexia, nausea, and vomiting. Three weeks ago, she returned from Guatemala, where she had engaged in missionary work.
On physical examination, temperature is 37.9 C. there is mild jaundice and a palpable, tender liver.
Labs:

Hematocrit 48%
WBC 9000
INR 1
Alk phos 110
AST 1100
ALT 1700
Total bilirubin 3

Which of the following laboratory tests is most likely to establish the diagnosis?
A) Anti HBs Ag
B) Anti HCV
C)Indirect hemagglutination test for Entamoeba histolytica
D) IgM anti HAV
E) EBV DNA

The answer is D
This pt's clinical and biochemical findings suggest acute hepatitis. She has recently returned from a country where hepatitis A virus is endemaic, and testing for IgM antibody to hepatitis A virus is indicated.
A positive test for antibody to hepatitis B surface antigen indicates only that the pt has been exposed to HBV. It does not indicated that she has acute HAV infection. There is nothing in the history to suggest acute hepatitis C viruse infection. In addition, determination of antibody to hepatitis C virus is not the appropriate test to diagnose this infectoin, as up to 40% of pts may have a negative test. The clinical picture is not consistent with an amebic liver abscess, and serum aninotransferase elevation to the degree noted in the pt are not typical for amebic liver disease. Therefore, an indirect hemagglutination test for Entamoeba histolytica is not indicated. Acute EBV infectoin is usually associated with pharyngeal discomfort, lymphadenopathy, and atypical lymphoctosis, which this pt does not have.

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Hot sauce
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