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Liver & GIT

6 out of 10

A 50 year old lady presented with history of painupper abdomen, nausea, and decreased appetite for 5 days. She had undergone cholecystectomy 2 years back. Her bilirubin was 10 mg/dl, SGPT 900 IU/L SGOT 700 IU/L and serum alkaline phosphatase was 280 IU/L. What is the most likely diagnosis - (AIIMS Nov 05)

A Acute pancreatitis

B Acute cholangitis

C Acute viral hepatitis

D Posterior penetration of peptic ulcer

Ans. C Acute viral hepatitis

Clinical Features:

1. Anorexia, nausea, vomiting, fatigue, jaundice, myalgia, headache, photophobia, pharyngitis, cough, coryza.

2. Serum sickness like syndrome occur in hepatitis B leading to urticarial rash, angioedema, high grade fever and arthritis.

3. Pain Right upper abdomen due to enlargement of liver.

4. Splenomegaly and cervical lymphadenopathy are seen in upto 20% cases.

5. Spider angioma appear during icteric phase and disappear during convalescence.

Laboratory Features:

1. ALT and AST rise, both > 500 IU/L, ALT > AST, ALP but < 3 times of normal - (normal ALP 30– 120 IU/L)

2. Serum bilirubin rise, and jaundice is usually visible in the sclera when serum bilirubin level are > 2.5 mg/dl.

3. Prolonged PT is associated with poor prognosis. Q

4. Hypoglycemia due to nausea, vomiting, inadequate intake and poor hepatic glycogen reserves.

5. Microscopic hematuria and proteinuria especially in hepatitis B. Q

6. Elevation of gamma globulin. IgM level is elevated more characteristically during acute hepatis A. Q

7. False positive RA factor and ANA.

8. Antibodies to liver kidney microsomes (LKM) in hepatitis C and D. Q

Liver & GIT Flashcard List

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