Urin was tea-coloured

1. Why does the patient had stomach discomfort & poor apetite?

2. Cause of icterus (definition and patophysiology)? DEFINITION: Jaundice, also called icterus, is marked by yellow discoloration of the skin, sclera (white) of the eye, deeper tissues and body fluids. The yellow discoloration is caused due to increased level of bilirubin in the blood. Jaundice is not a disease but it is a symptom that signifies an underlying disorder. TYPE AND PATOPHYSIOLOGY: Hemolytic Jaundice: Hemo means blood and lytic means breakdown of cells; together hemolytic means breakdown of red blood cells. In hemolytic jaundice or pre-hepatic jaundice, the bilirubin level is raised due to excess breakdown of red blood cells. Obstructive Jaundice: Also known as post-hepatic jaundice is caused by obstruction of bile flow from the liver. This increases the level of bilirubin in the blood, thereby causing

obstructive jaundice. Obstructive Jaundice can cause extreme pruritus (itching) due to build up of salt and other biles constituents. Hepatocellular Jaundice: This type of jaundice is very common and occurs due to inability of the liver to metabolize and remove bilirubin from the biliary system. Neonatal Jaundice: This type of jaundice is usually harmless. Neontal jaundice is marked by yellow discoloration of skin and other tissues of a newborn. The symptoms generally become apparent on the second or fourth day after the baby is born and disappear on it own within two to three weeks. CAUSE: Causes of Hemolytic Jaundice: Some of the common causes of hemolytic or prehepatic jaundice are sickle cell anemia, malaria, thalassemia, autoimmune disorders, etc. Causes of Obstructive Jaundice: Some of the common causes of obstructive jaundice or post-hepatic jaundice are carcinoma in the bile duct or gall bladder, presence of gallstones in the biliary system, infection by parasites, pancreatitis, etc. Causes of Hepatocellular Jaundice: Some of the common causes are cirrhosis, cancer, hepatitis, Gilberts syndrome, toxins or drugs, etc. http://blog.ygoy.com/2009/06/03/types-of-jaundice-and-causes/ 3. Why the urine of this patient tea-colored? Metabolism of bilirubin:

4. Why she complained for having fomitting and nusea? 5. Why she had a high fever? 6. The cause of hepatitis ? Acute hepatitis has a number of possible causes. Infectious viral hepatitis, such as hepatitis A, hepatitis B, hepatitis C, hepatitis D and hepatitis E. Other viral diseases, such as glandular fever and cytomegalovirus. Severe bacterial infections. Amoebic infections. Medicines, eg paracetamol poisoning and halothane (an anaesthetic). Toxins: alcohol and fungal toxins, eg toadstool poisoning. Chronic hepatitis also has a number of different causes. Infectious hepatitis, such as hepatitis B, hepatitis C and hepatitis D. Drug reactions. Toxins, such as alcohol.

Autoimmune hepatitis. This is a disease in which a number of liver cells are destroyed by the patient's own immune system. Autoimmune hepatitis can also sometimes occur as acute hepatitis. The cause is unknown. Inborn metabolic disorders, such as Wilson's disease (disorder of the body's copper metabolism) and haemochromatosis (disorder of the body's iron metabolism). http://www.netdoctor.co.uk/diseases/facts/hepatitis.htm 7. Why she complained tenderness in right upper quadran abdominal? 8. Why the doctor suggest transaminase enzime test? AST, or aspartate aminotransferase, is 1 of the 2 "liver enzymes." It is also known as serum glutamic-oxaloacetic transaminase, or SGOT. AST is a protein made by liver cells. When liver cells are damaged, AST leaks out into the bloodstream and the level of AST in the blood becomes higher than normal. AST is different from ALT because AST is found in parts of the body other than the liver--including the heart, kidneys, muscles, and brain. When cells in any of those parts of the body are damaged, AST can be elevated. http://www.hepatitis.va.gov/patient/diagnosis/labtests-AST.asp 9. Why do we need both of the examination (SGOT, SGPT)? SGOT: Serum glutamic oxaloacetic transaminase, an enzyme that is normally present in liver and heart cells. SGOT is released into blood when the liver or heart is damaged. The blood SGOT levels are thus elevated with liver damage (for example, from viral hepatitis) or with an insult to the heart (for example, from a heart attack). Some medications can also raise SGOT levels. SGOT is also called aspartate aminotransferase (AST). It facilitates the conversion of aspartate and alpha-ketoglutarate to oxaloacetate and glutamate, and vice-versa. SGPT: Serum glutamic pyruvic transaminase, an enzyme that is normally present in liver and heart cells. SGPT is released into blood when the liver or heart are damaged. The blood SGPT levels are thus elevated with liver damage (for example, from viral hepatitis) or with an insult to the heart (for example, from a heart attack). Some medications can also raise SGPT levels. Also called alanine aminotransferase (ALT). It catalyzes the transfer of an amino group from alanine to a-ketoglutarate, the products of this reversible transamination reaction being pyruvate and glutamate. http://www.hepatitis.va.gov/patient/diagnosis/labtests-AST.asp 10. Why the doctor write a prescription vitamin and recommend a proper diet? 11. DD?

HEPATITIS
DEFINITION: Hepatitis is inflammation of the liver. The inflammation happens when liver cells die and the body's immune system sends in special cells that actually cause inflammation while trying to help the body repair the liver. Such inflammation may clear up on its own, or continue on as chronic inflammation. http://hepatitis.about.com/od/ghi/g/hepatitis.htm CLINICAL MANIFESTATIONS: Loss of appetite Fatigue

 Mild fever Muscle or joint aches Nausea and vomiting Abdominal pain http://www.webmd.com/hepatitis/default.htm Acute hepatitis The symptoms of acute hepatitis vary considerably from person to person. Some patients have no symptoms at all, and in most cases, children only show mild symptoms. In the early stages: tiredness, general malaise, slight fever nausea, poor appetite, changes in taste perception pressure or pain below the right ribs caused by an enlarged liver aching muscles and joints, headache, skin rash. The jaundiced phase: yellowing of sclerae (the whites of the eyes), skin and mucous membranes dark urine light-coloured stools around this time, the other symptoms subside. The recovery phase: tiredness that can last for weeks. Chronic hepatitis Many patients have no symptoms. Tiredness, an increased need for sleep, aching muscles and joints. Periodic light pressure or pain below the right ribs enlarged liver. Jaundice is a very late symptom of chronic hepatitis. It is a sign that the disease has become serious. http://www.netdoctor.co.uk/diseases/facts/hepatitis.htm 12. Patophysiology?

13. Treatment & therapy? How can hepatitis be prevented? By avoiding exposure to the infectious hepatitis viruses. By being vaccinated against hepatitis A and hepatitis B, if you have a high risk of being infected. By refraining from drinking large amounts of alcohol. Treatment & therapy: No medical treatment is generally required for acute viral hepatitis. Chronic hepatitis B can be treated with interferon alfa or other antiviral agents. Chronic hepatitis C can be treated with interferon alfa and ribavirin (tribavirin). Autoimmune hepatitis can by treated with corticosteroids. http://www.netdoctor.co.uk/diseases/facts/hepatitis.htm