Course 1
Case 13
Case report 1-13E: A 22-year-old woman with fever, dyspepsia and jaundice
Family history: Father healthy, mother has got cholecystolithiasis, sister healthy.
Personal history: Common childhood illnesses, more common tonsillitis.Regular vaccination in
childhood. Operations: tonsillectomy at the age of 10, injuries: cerebral comotion at the age of 15
after fall on ice. No regular medication. No known alllergy.
Epidemiological data: No known contact with infection, no travel abroad. A month ago she was
camping with friends for a week.
Social history: Works as cashier at the supermarket. Lives with boy-friend. Alcohol occasionally,
no smoking, no drug abuse.
Current illness: About 5 days is feeling sick, has got fever 38-38,5 °C, myalgia, after ibuprofen
some relief of symptoms. Last days has no appetite, nausea, abdominal pain. Today she noticed
yellow eyes, therefore went to the doctor.
Physical examination: T 37,8 °C. Conscious, orientated. Eutrophic, hydration normal. Skin
subicteric (mild jaundice), no rash. Icteric sclerae, otherwise eyes, nose and ears with no
pathology, throat with no inflammation. No lymphadenopathy. Eupnoic, normal lung and heart
sounds, HR 80/min, reg., BP 120/80. Abdomen soft, well palpable, slightly painful right
hypochondrium, no peritoneal signs, liver enlarged 3 cm, no splenomegaly. Meningeal signs
negative.
Laboratory results:
Blood count: leukocytes 6.000/μl, erythrocytes 4.3 mil/μl, hemoglobin 140 g/l, hematocrit 0.41,
thrombocytes 310.000/μl
Serum: glucose 4.6 mmol/l, urea 7.2 mmol/l, creatinine 75 μmol/l, Na 140 mmol/l, K 4.1 mmol/l,
Cl 108 mmol/l, bilirubin total 90 mmol/l, conjugated 28 mmol/l, ALT 28.5 μkat/l, AST 18.1
μkat/l, ALP 2.1 μkat/l, GMT 1.5 μkat/l, CRP 22 mg/l.
Urinalysis: bilirubin positive, urobilinogen positive, others negative
Questions and tasks:
1. Describe bilirubin metabolism.
2. What is the likely etiology?
3. What test can detect the etiology?
4. How is this infection transmitted?
5. How can be this infection prevented?
6. What is fulminant hepatitis?
Pathology:
Viral hepatitis
Pathophysiology:
Classification of icterus