Glass Slide M8
Glass Slide M9
Glass Slide M10
Glass Slide M11
Mr. Roger Flambards is a 60-year-old retired stockbroker. He is seen because he has bilateral parotid enlargement, a right Dupuytren’s contracture, and has developed increasing abdominal swelling. On examination it is apparent that the cause of his abdominal swelling is ascites. He also has spider nevi, mild ankle edema, splenomegaly, and a firm, slightly enlarged liver. Further investigations are performed.
| Lab Test Investigation | Result |
|---|---|
| Complete blood count | Macrocytosis |
| Serum bilirubin | Moderately elevated |
| Serum alanine transaminase | Moderately elevated |
| Serum aspartate transaminase | Moderately elevated |
| Serum alkaline phosphatase | Mildly elevated |
| Serum albumin | Reduced |
| APTT | Greatly prolonged |
| Hepatitis-B serology | Negative |
| Blood ethanol (10:30am) | 80 mg/dl |
After correction of his blood clotting abnormality, a liver biopsy is performed which shows established cirrhosis with features consistent with an alcoholic etiology. (glass slide M8)
Glass Slide M8 |
Glass Slide M9 |
Glass Slide M10 |
Glass Slide M11 |
What are the pathological features seen in the liver in cirrhosis?
What histological features suggest an alcoholic causation?
What are the complications of cirrhosis?
What are the possible etiologies of cirrhosis?
Mr. Eric Gribble is an unemployed 49-year-old security guard, recently dismissed after several prisoners escaped from his custody. His personal circumstances had not improved and he had been recently separated from his wife because of several episodes of domestic violence. He is admitted as an emergency to the hospital accompanied by a friend. The two of them had been having a drinking session which had been going on for about five days. His friend had found Eric collapsed in the kitchen hunched forward over a chair with severe abdominal pain. An ambulance had been called.
| Lab Test Investigation | Result |
|---|---|
| Complete blood count and ESR | Neutrophil leukocytosis |
| Serum amylase | Greatly elevated |
| Serum albumin | Moderately reduced |
| Serum calcium | Reduced |
| Bilirubin | Mildly elevated |
| Serum alanine transaminase | Mildly elevated |
| Serum aspartate transaminase | Mildly elevated |
| Serum alkaline phosphatase | Mildly elevated |
| Abdominal X-ray | No free air seen beneath diaphragm |
On examination, he is shocky and has severe abdominal tenderness. After an intravenous line and a nasogastric tube are inserted, investigations are performed. A diagnosis of acute pancreatitis is made.
 Glass Slide N2 |
 Glass Slide N3 |
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What are the main causes of acute pancreatitis?
What is the pathogenesis of acute pancreatitis?
What are complications of acute pancreatitis?
A 55 year old obese woman was admitted to the hospital with a sudden onset severe abdominal pain associated with nausea and vomiting. The pain was constant in nature and unrelieved by movement or change in posture. The pain was felt with maximum intensity in the epigastrium and right upper abdomen with radiation into the lower chest. The patient had no history of peptic ulcer disease, gallstones or alcohol intake. She was afebrile. Blood pressure was 110/85 mm Hg, heart rate was 92 beats per minute and respiration was 20 per minute. The abdomen was slightly tender on palpation. All laboratory values were within normal limits. Plain radiograph of the abdomen showed numerous calcifications in the right upper abdomen. The pain started subsiding in about 4 hours and was completely resolved in a few more hours. The following day the patient was discharged.
This patient's abdominal pain is most likely due to:
All of the following statements about the primary problem for which this patient was admitted are true EXCEPT:
An increase in concentration of which of the following in bile favors the formation of gallstones?
Several months later the patient was readmitted to the hospital complaining of severe abdominal pain of 2 days duration accompanied by nausea and vomiting. This time the pain was colicky in nature and was getting worse. The patient had fever with chill and rigors. On physical examination the right upper abdomen was tender with guarding. Ultrasound showed multiple stones in the gall bladder with one impacted in the common bile duct. The patient was taken to surgery for cholecystectomy and removal of stones from the duct.
| Laboratory Test | Result | Normal Range |
| Complete blood count | mildly elevated neutrophil count | |
| Glucose | 110 mg/dL | (65-110) |
| BUN | 21 mg/dL | (7-24) |
| Calcium | 9.3mg/dL | (8.5-10.5) |
| Total protein | 7.1g/dL | (6.0-8.00) |
| Albumin | 4.4 g/dl | (3.7-5.0) |
| Alkaline phosphatase | 238U/L | (30-120) |
| AST | 392 U/L | (0-55) |
| GGTP | 242 U/L | (0-50) |
| Bilirubin | 3.7 mg/dL | (0-1.1) |
| Bilirubin direct | 2.85 mg/dL | (0.02 - 0.18) |
| Serum amylase | 80nU/L | (23 - 85) |
| Serum lipase | 16 U/L | (4 - 24) |
This patient's abdominal pain is most likely due to:
Which of the following statements concerning the laboratory findings in this patient is correct?
The histologic findings in Slide are most consistent with:
All of the following are possible consequences of cholelithiasis EXCEPT: