Here is a puzzle for you to consider. One of my residents told me that I needed to post more clnical problems.
Patient is 28-year-old white male with new jaundice. His only significant medical history is a 6-month history of grand mal seizures with a normal head CT.
He has noticed pale stools and dark urine for 3 days. He complains of epigastric pain.
Social history – previous work as an EMT ambulance worker. Had significant blood exposure 6 months ago (saved the life of a woman who jumped out of window).
His exam was remarkable for jaundice and a slightly enlarged liver.
Lab tests:
Normal CBC, normal basic metabolic panel
| Destruction | Obstruction | Factory | |||
| AST | 966 | alk phos | 188 | albumin | 3.9 |
| ALT | 1784 | T. Bili. | 7.5 | INR | 1.1 |
Direct bilirubin – 5.8
Your job:
construct a differential diagnosis and make your best guess for the correct answer. We do know the answer.
