Question

Arnold is a 57-yr old male who lives alone. He has always been in good health until about a two years ago, when he was in a car accident and suffered injuries severely limiting his mobility and activities of daily living. Since that time his diet and level of physical activity have dramatically changed. He eats primarily convenience foods and very little fresh food which he knows are not as healthy, but cannot shop and cook for himself very easily. He has made progress with physical therapy, but in spite of this, he continues to experience chronic fatigue pain, which prompted a visit to his primary care physician. He was given series of initial screening tests including a (fasting) blood chemistry profile, urinalysis and complete blood count (CBC). Data are shown below.

Height: 67 in Weight: 155 lbs BMI: 24.3 (normal) Blood Pressure: 137/92 mmHg Waist circumference: 42.5 inches DXA t-score: 1.7	Urinalysis: Negative: RBC, glucose, ketones Specific gravity: within normal limits Other measurements normal
Blood chemistry profile: Fasting Blood Glucose: 109 mg/dL HbA1c: 6.2% HDL Cholesterol: 23 mg/dL Triglycerides: 250 mg/dL	Complete blood count (CBC): MCV: high Hbg, hct, serum folate, RBC folate: low Serum iron: increased

1. Given what you know about his symptoms and information above, what could Arnold be diagnosed with? For each diagnoses offered, please provide what in the information given, supports it.

Answer 1

Arnold has high triglycerides and low HDL level .

Raised blood pressure

High MCV and low Hb , serum folate , RBC folate .

Raised serum iron

All these above mentioned abnormal conditions results in usually liver or pancreatic disease .

Symptoms seen are -

Abdominal pain

Loss of weight and appetite

Pallor

Yellowing of skin and sclera

Nausea

Weakness

Fatigue and body pain

Anaemia like symptoms

These all symptoms suggest diagnosis of liver problem due to malnutrition which usually results after his car accident 2 years back after which he has less intake of food and decreases stamina due to limiting mobility.  

This usually suggests hepatitis - as triglycerides raised and HDL decreased .

Can also due to pancreatitis .

Serum iron raised and less Hb indicates red cell haemolysis before entering liver . May suggestive of haemolytic anemia and also liver disease which results in red cell haemolysis.