Question

A 44-year-old man, an emergency medical technician, has felt fatigued for the past 4 months. He experienced an episode of jaundice 10 years ago, but that resolved and he has been healthy since. On physical examination there are no remarkable findings. Laboratory studies show his hemoglobin is 14 g/dL and serum electrolytes normal, but he has a total protein of 5.4 g/dL, albumin 2.9 g/dL, ALT 132 U/L and AST 113 U/L with total bilirubin 1.3 mg/dL and direct bilirubin 0.8 mg/dL. A liver biopsy is performed and microscopic examination shows interface inflammation with extension of inflammation into the lobules from the triads. There is focal ballooning degeneration of hepatocytes. These are the symptoms of ______________

Answer 1

The symptoms and laboratory findings, including elevated liver enzymes and biopsy results showing chronic inflammation, suggest a diagnosis of chronic hepatitis in the 44-year-old emergency medical technician.

Step-by-step explanation:

Considering the laboratory findings of a 44-year-old man, who is an emergency medical technician presenting with fatigue and past episodes of jaundice, the elevated levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST), and bilirubin, along with the liver biopsy showing interface inflammation and focal ballooning degeneration of hepatocytes, suggest a diagnosis of a chronic liver condition. The inflammation extending into the lobules from the triads, an indication of ongoing damage to the organ, points towards a disease process affecting the liver parenchyma. Bearing in mind the clinical presentation and lab results, these are symptoms indicative of chronic hepatitis.

While acute liver failure is associated with rapid development of hepatic encephalopathy and decreased production of proteins, the patient's liver function test results, combined with the absence of encephalopathy symptoms, do not align with this diagnosis. Furthermore, the patient's bilirubin levels are elevated, but not to the extent that would be indicative of a severe disorder like Crigler-Najjar syndrome or Gilbert's syndrome. Instead, the pattern of laboratory findings, alongside the histological features described in the liver biopsy, provides evidence of an ongoing inflammatory process rather than acute liver failure or a primary bilirubin metabolism disorder.