Gastrointestinal System


{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/P14_F1.jpg"}},{"insert":"\n\n"},{"insert":"It has been a busy morning so far. After seeing a series of patients in your clinic, you are finally ready to head on to your ward.\n\nAs you walk into the ward, your intern greets you and asks if you\u0027re ready to start the ward round. You nod \u0022yes\u0022, and she escorts you over the first patient, and starts presenting the case.\n"}]}


{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/P14_F2.jpg"}},{"insert":"\n\n"},{"insert":"You are introduced to 2-week-old Hannah, and her mother, Sue.\n\nHanna was admitted around an hour ago after she started passing acholic stools earlier today. She has had no other symptoms and has been feeding normally so far.\n\nThe antenatal period was without incident. Hannah was born at 40 weeks of gestation, via an uncomplicated vaginal delivery. Her Apgar score was 8\/9, and birth weight was 2.590 kg.\n\nHannah\u0027s family history is unremarkable. Sue shows you several photos of Hanna\u0027s stools - you immediately recognize them to be acholic.\n"}]}


{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/P14_F3.jpg"}},{"insert":"\n\n"},{"insert":"Your intern starts presenting the examination findings. Even before she mentions this, you notice that Hannah is visibly icteric, with her eyes, face, chest, and upper abdomen involved.\n\nHannah\u0027s weight is 2.700 kg. Her vital signs are stable, no dysmorphic features are discernible, and she is not pale. There are no petechiae or ecchymoses. There is no hepatosplenomegaly.\n\nExamination of the heart and lungs shows no abnormalities.\n"}]}


{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/P14_F5.jpg"}},{"insert":"\n\n"},{"insert":"Your intern also ordered a panel of investigations. You quickly peruse through the results.\n\nWBC: 10,000\/mm3 (8,000 - 14,300) \r\nHb: 15.1 g\/dL (12.7 - 18.3) \r\nPlatelets: 305,000\/L (234,000 - 346,000)\r\nReticulocyte count: 0.5% (\u003C0.1 - 1.2)\n\nPeripheral blood smear: no abnormalities \r\nMaternal blood group: O+ \r\nInfant\u0027s blood group: O+\n\nTotal bilirubin: 210 \u03bcmol\/L \r\nConj. bilirubin: 99 \u03bcmol\/L (\u003C10 mmol\/L)\nAlbumin: 2.7 g\/dL (2.6-3.6) \r\nALT: 30 IU\/L (7 - 45) \r\nAST: 25 IU\/L (8 - 50) \r\nALP: 400 IU\/L (95 - 368) \r\nGGT: 33 IU\/L (7 - 19)\n\nTSH: 5.1 mU\/L (0.72 - 13.10) \r\nT4: 211 nmol\/L (81 - 276) \r\nAlpha-1-antitrypsin: 160 mg\/dL (143 - 440)\n\nA urinalysis, chest x-ray, and sweat test are all normal.\n"}]}


{"ops":[{"insert":"Will you order any other investigations?\n"}]}
1. No, not for now
2. Yes, a septic screen
3. Yes, an abdominal ultrasound