Case 2

1. Identify salient historical information that my have a bearing to this patient's chief complaint. Elaborate on the significance of each.  Answer

He has two stages to his illness one following surgery and another 4 years later

2. List salient findings in his first ER visit Elaborate on the significance of each.  Answer

3. List salient findings in his second  ER visit in 2 months Elaborate on the significance of each.  Answer

4. What is Gilbert’s syndrome?  What would the  fractionation  of bilirubin show in patients with Gilbert’s?  Answer

5. Explain the pathophysiology behind Gilbert’s syndrome.  Answer

6. Is Gilbert’s syndrome associated with disease?  What harm can result from chronically elevated Bilirubin?  Answer

7. What is the most likely etiology for his Jaundice in post op hospitalization period?  Answer

8. During the patient’s pot-op hospitalization, what additional tests should be performed?  Answer

9. What is the significance of the ultrasound findings?  Answer

10. What is sludge?  Answer

11. What is the significance of the history of Gilbert's disease. Is it a factor in his Jaundice?    Answer

12. Discuss a differential diagnosis for this patient when he visits the ER 4 years later for the first time.   Answer 

13. What additional tests would you do as a result of this first ER visit?   Answer

14.  Discuss the laboratory result obtained during the second ER visit.  Answer

15. What comments would you make regarding the rapid weight loss liquid protein diet?  Answer 

16. What definitive recommendations would you make for this patient at this time?   Answer