Question

A 24 years old student visits the general practitioner with fatigue complaints. The symptoms start directly when waking up, in addition he also suffers pain under the right costal arch. He is an active member of a student fraternity, the father of the boy died at a fairly young age due to myocardial infarction (heart attack). Physical examination provides no details. The liver region is somewhat sensitive to palpation.

Lab results:
Test Result Reference range
Glucose: 2.8 (sober) 3.5-5.6
Bilirubin 12 <17
Bil. direct - 20-40
Alk. phosphatase 124 40-130
GGT 94 15-45
ASAT 48 15-45
ALAT 22 10-50
Cholesterol 6.4 3.5-6.5
Triglycerides 2.4 0.5-2.0
HDL-cholesterol 0.8 <0.9

What can be diagnosed?

Answer 1

What are you having trouble understanding?

Answer 2

GGT 94 15-45
Triglycerides 2.4 0.5-2.0
Cholesterol 6.4 3.5-6.5

The patient has trouble absorbing fats into his body. Probably a bile issue. This can be the primary reason he is feeling fatigue. Could be be suffering from hepatitis? Or gall bladder? Can we see a CT-scan of his abdomen/pelvis to rule out cholecystolithiasis. He is tender to the right upper quadrant of his abdomen.

I like these type of questions!

Answer 3

Well I have a lot of these case-based clinical chemistry questions to do :P
I think this one would definitely be liver damage either due to hepatitis or alcohol abuse (since you know, he's a student :P)

Answer 4

hahaha. I didnt think of alcohol abuse........ gawddd....... Good question. Keep them coming prof!