PBL Sessions: Reproductive Organ System


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Page 6

History of Present Illness:

The patient is seen a year later in the clinic of her local health plan. She has had a weight loss of 5 kg over the past month, and her skin has turned a yellow color. Vital signs shows T 37 C, P 81, R 16, and BP 100/70 mm Hg. A physical examination reveals scleral icterus as well as generalized jaundice. She has a slightly enlarged abdomen and there is a fluid wave. It is difficult to palpate the liver. Her lungs are clear to auscultation and her heart rate is regular.

The patient was currently taking oral contraceptives, but was not on any other medications.

Laboratory findings include sodium 139 mmol/L, potassium 4.0 mmol/L, chloride 99 mmol/L, CO2 25 mmol/L, creatinine 1.2 mg/dL, glucose 72 mg/dL, total protein 5.6 g/dL, albumin 3.5 g/dL, alkaline phosphatase 365 U/L, AST 222 U/L, ALT 241 U/L, total bilirubin 14.8 mg/dL, and direct bilirubin 12.9 mg/dL.

Coagulation studies show prothrombin time 14 seconds (control 11 - 15 seconds) and partial thromboplastin time 51 seconds (control 25 - 35 seconds). With a 1:1 mixing study (1 part patient plasma with 1 part normal plasma) the PTT does not correct, but remains prolonged.

She was taken for an abdominal ultrasound and CT imaging. These tests revealed massive ascites as well as hepatomegaly. The spleen was slightly enlarged. The gallbladder was not dilated and no stones were present.

Tasks

  • What do these findings indicate?

  • What hypotheses explain these findings?

  • Explain your reasoning for the hypotheses you choose.

  • Is there anything that can tie these findings together?

Stop !! Complete discussions and tasks before moving to the next page.