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What is the significance of a direct bilirubin of 10.3 mg/dL when the total bilirubin is 15.5 mg/dL?

What is the significance of a direct bilirubin of 10.3 mg/dL when the total bilirubin is 15.5 mg/dL?

A 42 year old woman was admitted to the ER with complaints of nausea, vomiting, chills, fever, and severe right upper quadrant pain. She had experienced similar symptoms a few times in the past 6 months but the episodes had been much milder and had disappeared in 2-3 hours. The ER physician noticed that she was visibly jaundiced and ordered a hepatic function panel:

Patient

Reference Range

Total Protein

7.4

6.4-8.3 g/dL

Albumin

4.0

3.5-5.2 g/dL

Total bilirubin

15.5

0-2.0 mg/dL

Direct bilirubin

10.3

0.0-0.2 mg/dL

ALP

645

53-128 U/L

AST

100

<35 U/L

ALT

105

<45 U/L

Additional results revealed:

Patient

Reference Range

GGT

400

<55 U/L

Amylase

98

28-100 U/L

Cholesterol

330

<200 mg/dL

1. In this case, the patient was visibly jaundiced. Which lab results correlate with a jaundiced patient?

2. Symptoms in this case correlate with acute appendicitis, cholelithiasis, cholangitis, hepatitis, pancreatitis, and cholecystitis. Which conditions are associated with the 4 F’s (female, forties, fat, fertile (estrogen promotes secretion of bile salts)?

3. What is the significance of a direct bilirubin of 10.3 mg/dL when the total bilirubin is 15.5 mg/dL?

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