Naked Science Forum

Life Sciences => Physiology & Medicine => Topic started by: hawaiilover on 31/05/2007 09:48:57

Title: Medical Challenge, Week 1
Post by: hawaiilover on 31/05/2007 09:48:57
Greetings all from the Aloha state. I have just discovered this wonderful forum at the same time as the tv show, "House" and I must admit I am hooked. I have become obsessed with learning all I can about diseases and medicine in an attempt to better understand the show and have devised what I think is a fun game I can share with you all.

Each week I will pick one of the diseases I am studying in my free time and make up a fake patient for you all to diagnose. The first person to sucessfully diagnose the condition will get 1 point. The first person to diagnose the actual disease will get 2 points. If you diagnose both, you get all 3 points.

A running tally will be kept of each person who sucessfully diagnoses each patient.

The ultimate goal is to bask in the title of top diagnostician of the Naked Scientists, a most prestigious title that I am sure will spur some stiff competion.

While this may sound daugnting, it will not be as complicated as it may seem. I am not yet a doctor, and so will not be spouting off the kind of language found on modern medical dramas, regarding blood tests results, and medical jargon, but rather the most basic form of description of symptoms.

I am studying and getting my info from medicinenet.com, so a little bit of research should be enough to diagnose each patient. Note all necessary and relevant info will be made available from the get go.

So with the introduction to the challenge being made, here is the first case.

CASE 1: patient reports itching of skin. In addition the following have all turned brown, urine, whites of eyes, skin. Patient also reports considerable lightening of stool coloration.

-important fact: no abdominal pain, (this will help eliminate many potential diseases)

Relevant personal history: Patient is unemployed Vietnam vet who drinks heavily

-important fact: patient does not take drugs,(relevant in eliminating possible diseases).

Good luck and have fun
Title: Medical Challenge, Week 1
Post by: iko on 31/05/2007 10:41:17
- Alcohol-induced cholestasis

- Pancreatic head CA.
Title: Medical Challenge, Week 1
Post by: Karen W. on 31/05/2007 10:51:19
AGENT ORANGE ..LOL
Title: Medical Challenge, Week 1
Post by: iko on 31/05/2007 12:02:03
Quote from: Karen W. on 31/05/2007 10:51:19
AGENT ORANGE ..LOL

No Karen,

the patient himself looks ORANGE (jaundice)!   [;D]

BTW, this moderator(KW)
- in my opinion -
should moderate more
moderately and...
RELAX a bit more!

(https://www.thenakedscientists.com/forum/proxy.php?request=http%3A%2F%2Fwww.jamesshuggins.com%2Fi%2Fhum1%2Faddicted.jpg&hash=e636a32895d0deb50a4750a9d3960c5c)
http://www.jamesshuggins.com/i/hum1/addicted.jpg
Title: Medical Challenge, Week 1
Post by: chris on 31/05/2007 12:27:49
The patient is jaundiced. The findings of pale stools, cholestasis (itching) and abdominal pain are suggestive of an obstructive (post-hepatic) picture. The absence of pain rules out pancreatitis or cholecystitis. The past history of chronic alcoholism indicates a risk of cirrhosis and hepatocellular carcinoma and also places the patient at risk of biliary stricture.

My differential would therefore include:

- Biliary obstruction secondary to stricture or gallstones.
- Hepatocellular carcinoma with compressive obstruction of the right or left hepatic duct.
- Pancreatic cancer with biliary obstruction.
- Liver flukes or other parasites (e.g. hydatid disease).

Further information that should be sought from the patient - any weight loss recently, any temperatures?

Immediate management:

IV access, fluids to rehydrate.

Blood tests for liver function, serum amylase, tumour markers, renal function and full blood count, haematinics (iron status).

Further investigations and treatment:

- Urgent ultrasound to image gall bladder, liver and pancreas
- Follow up ERCP +/- stent if indicated
- CT if indicated.

Chris
Title: Medical Challenge, Week 1
Post by: elegantlywasted on 31/05/2007 16:20:48
jeez Chris... why do you always have to sound like such a doctor!?!?! [;)]
Title: Medical Challenge, Week 1
Post by: adamagalas on 01/06/2007 20:05:09
Ok, well here are the results of some tests to help you to nail down the exact diagnosis.

MRI shows no bile duct blockage or inflamation

Blood tests indicate renal function normal, copper and iron levels are also normal.

Liver biopsy shows no inflamation but scarring.

So now its a race to name the obvious and get 2 points. Iko is awarded 1 point for correctly stating "Jaundice" first. But what caused the Jaundice? Use the above info to name the cause and take the lead.

Good luck, but you certainly won't need it.
Title: Medical Challenge, Week 1
Post by: chris on 01/06/2007 23:25:11
Ok, the guy's got liver failure secondary to cirrhosis secondary to chronic alcoholism.

Chris
Title: Medical Challenge, Week 1
Post by: iko on 01/06/2007 23:45:06
Primary biliary cirrhosis

aggravating factors:
chronic alcohol abuse
(HBV/HCV hepatitis?)

Quote
Summary of stages
Stage 1 - Portal Stage: Normal sized triads; portal inflammation, subtle bile duct damage. Granulomas are often detected in this stage.
Stage 2 - Periportal Stage: Enlarged triads; periportal fibrosis and/or inflammation. Typically characterized by the finding of a proliferation of small bile ducts.
Stage 3 - Septal Stage: Active and/or passive fibrous septae.
Stage 4 - Biliary Cirrhosis: Nodules present; garland or jigsaw pattern.

Etiology
The cause of the disease is unknown at this time, but research indicates that there is an immunological basis for the disease, making it an autoimmune disorder. Most of the patients (>90%) seem to have auto-mitochondrial antibodies (AMAs) against pyruvate dehydrogenase complex (PDC-E2), an enzyme complex that is found in the mitochondria. In addition, a more specific test to confirm this disease from a bone disorder such as Paget's (disease of bone) which also has increases in Alkaline phosphatase is the Gamma-glutamyl trans peptidase test (GGTP). An increase in GGTP could indicate presence of Primary Biliary Cirrhosis.


Therapy
There is no known cure, but medication may slow the progression so that a normal lifespan and quality of life may be attainable for many patients. However, specific treatment for fatigue, which may be invalidating in some patients, is unavailable. Ursodeoxycholic acid (Ursodiol) is the most frequently used treatment. This helps reduce the cholestasis and improves blood test results (liver function tests). It has a minimal efect of symptoms and whether it improves prognosis is controversial. To relieve itching caused by bile acids in circulation, which would normally be removed by the liver, cholestyramine (a bile acid sequestrant) may be prescribed to absorb bile acids in the gut and be eliminated, rather than re-enter the blood stream. As in all liver diseases, alcoholic beverages are contraindicated. In advanced cases, a liver transplant, if successful, results in a favourable prognosis.

from:  http://en.wikipedia.org/wiki/Biliary_cirrhosis#Signs_and_symptoms
Title: Medical Challenge, Week 1
Post by: adamagalas on 02/06/2007 06:20:39
Chris is correct, Cirrhosis of liver, 2 points

See you all next week, (Thursday) with another case.