Somali Medical Forums
Medical Student Forums => Questions, Exams & Study tips => Topic started by: Shenamic on May 18, 2011, 04:30:17 PM
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Dear Somalidoc Users, Here are two Case Histories (CH's) to share with you. See if you can grasp and answer the Questions following the two CH's
CH1: A 15-Years-old girl presented with abdominal pain and diarrhea for 3days, She became Jaundiced and a Presumptive diagnosis of Infective Hepatitis was made, But Serological tests were negative. She Subsequently died of Fulminant Liver failure. At post mortem her liver Copper concentration was found to be grossly increased, What investigations should be created on this Patients young Sister?
CH2: Mrs Asha. who has been receiving digoxin for mild hearl failure.presented at The geriatric day hospital complaining of nausea. On examination she was found to have bradyardia and appeared dehydrated. Her digosin concentration. Taken 6 hour afler her morning dose of 0.125 mg, was found to be 3.1 nmol/I (Ihernpeulicrange 0.7-2.5). On Questioning, It emerged thal she had been vomiting for Three Days. Her Serum Creatinine was elevated, Explain Digoxin result?
I will share the my Comments on the CH's with you, But let's see yours first.
Good luck and Thanks.
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CH1: Your patient died due to Wilson's disease and since this disease is autosomal recessive genetic disorder I will screen family members for the disease as part of clinical genetics family counselling if not yet the disease affected them showing the signs of copper accumulation in their eyes, kidneys, brain and liver.
CH2: Probably the lady has digitalis toxicity which may be exacerbated due to the vomiting because deteriorating renal function, dehydration, electrolyte disturbances, or drug interactions usually precipitates toxicity. (that's if the vomiting preceded the nausea and bradycardia as result of digoxin toxicity).
Wish you the best