Scenario P.M., 24-year-old house painter, too ill to work the past 3 days. Arrived at your outpatient clinic with his girlfriend, he seems alert but acutely ill, with an average build & a deep tan over the exposed areas of skin. He reports headaches, joint pain, a low-grade fever, cough, anorexia, & nausea and vomiting (N/V), especially after eating any fatty food.
P.M. describes vague abdominal pain that started about the same time as the other problems. He states that he has been using “a lot of Tylenol” for his pain. His past medical history reveals he has no health problems, is a nonsmoker, & drinks “a few” beers each evening to relax.
Vital signs are 128/84, 88, 26, 100.6 ° F (38.1 ° C); awake, alert, & oriented × 3; moves all extremities well with complaints of aching pain in his muscles; very slight scleral jaundice present; heart & lung sound clear & without adventitious sounds; bowel sounds clear throughout abdomen & pelvis; & abdomen soft & palpable without distinct masses. You note moderate hepatomegaly measured at the midclavicular line; liver edge is easily palpated & tender to palpation. P.M. mentions that his urine has been getting darker over the past 2 days.
- Your institution uses electronic charting. Based on the health history and assessment described in the scenario, which of the following systems would you mark as “abnormal” as you document your findings? Mark abnormal findings with an X and provide a brief narrative.
X Abnormal
☐ Neurologic:
☐ Respiratory:
☐ Cardiovascular:
☐ Gastrointestinal:
☐ Genitourinary:
☐ Musculoskeletal:
☐ Skin:
☐ Pain:
Case Study Progress
P.M. is manifesting key signs of hepatitis. Laboratory work is requested for identification of his precise problem.
- Which key diagnostic tests will determine exactly what type of hepatitis is present?
Laboratory Test Results
| Sodium
Potassium Chloride CO2 BUN Creatinine Platelets Indirect bilirubin Total bilirubin Albumin Total protein ALT AST LDH ALP PT/INR aPTT Urine urobilinogen Anti-HAV IgM HBsAg |
140 mEq/L
3.9 mEq/L 102 mEq/L 26 mEq/L 10 mg/dL 1.3mg/dL 210,000/mm3 1.6 mg/dL 2.3 mg/dL 3.8 g/dL 6.5 g/dL 66 units/L 52 units/L 245 units/L 176 units/L 12 sec/1.06 32 sec 1.6 IU/L Negative Negative Positive |
- Which of P.M.’s laboratory results specifically indicate liver disease?
- What is the
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