A 50-year-old male arrives at the doctor with jaundice and a painful distended abdomen. His urine...

A 50-year-old male arrives at the doctor with jaundice and a painful distended abdomen. His urine is tea colored and bile salts are detected. Further assessment reveals the presence of bruises and mark on his arm indicative of IV drug use. What is the diagnosis? Why are there bile salts in his urine? Why is he jaundiced?

Expert Solution

Most probable diagnosis is Hepatitis B infection

Reason: there is jaundice, andominal pain and dark coloured urine which are indicative of a liver infection. The patient has history of iv drug abuse. It increases the risk of getting hepatitis B which can be transmitted by the usage of unclean needles.

Reason for bile salts in urine

Examples for bile salts are

Sodium glycocholate.
Sodium taurocholate.

Most of the bile salt gets absorbed in the terminal ileum and return to liver through the portal circulation for resecretion.The recycling of bile salts is called enterohepatic circulation.

Bile salts appear in urine when there is any obstruction to the biliary tract and bile increase in blood.

Here due to the liver damage bile acids and bile salts enter the bloodstream and it reaches kidney which then excreted via urine. So, there will be presence of bile salts in urine.

Reason for jaundice

In hepatits, liver gets damaged.
insoluble bilirubin is unconjugated bilirubin, it moves to the liver through the blood, bound to albumin. In the liver, the bilirubin gets conjugated with glucuronic acid to give bilirubin diglucuronide, conjugated bilirubin, which is the water soluble form of bilirubin that can be excreted.

This conjugated bilirubin leaves the liver and enters the biliary tree and cystic ducts and stored in gall bladder as part of bile.
Bacteria in the intestine convert the bilirubin into urobilinogen.
This urobilinogen is either converted into stercobilinogen and excreted through feces, or gets reabsorbed by the intestinal cells(enterohepatic circulation) and taken to the kidneys via the blood to be excreted in the urine.

when liver is damaged, conjugation process not taking place properly which causes more amount of unconjugated bilirubin in blood. It causes yellowish discoloration of skin and sclera.
This is how jaundice develops in hepatitis

Sydney Mullin answered 1 year ago

George, a 50-year-old male, visited his doctor when he noticed the whites of his eyes appeared...

George, a 50-year-old male, visited his doctor when he noticed the whites of his eyes appeared yellow and he had dark urine. His CBC revealed a hemoglobin of 31 g/L. Given his clinical description, name at least 2 lab tests that should be ordered to assist in diagnosis? George's only complaint was the yellow color of his eyes and dark urine. His CBC: Hb 3.1 g/dL, Hct 0.08 L/L RBC count 0.71 × 1012/ L RDW 21.6 Reticulocytes 22% Calculate...

Taylor is a 1 year old male at the doctor for his first-year wellness visit and...

Taylor is a 1 year old male at the doctor for his first-year wellness visit and necessary immunizations. Taylor's mother approaches the pharmacist abour concerning regarding the link between autism and immunizations. How would you respond to the concerns of his mother? Write an ethical response to her question (500 words roughly).

A 39-year old male arrives to the emergency department with a severely infected wound on his...

A 39-year old male arrives to the emergency department with a severely infected wound on his upper right arm. His laboratory results show a plasma glucose level of 223 mg/dl. From these laboratory results, should this patient be diagnosed with diabetes? In two sentences or less, provide a physiological rational for your answer to the question above.

A 21-year-old male visits with his family doctor at the urging of his parents when home...

A 21-year-old male visits with his family doctor at the urging of his parents when home for Spring Break. The parents are concerned because their son has lost a significant amount of weight. The young man is concerned because he is experiencing a heart rate of 120bpm while at rest and much higher when exercising. Additionally, his blood pressure averages 137/82 based upon four recordings. He has a recurring headache, tremors in his hands and suffers dyspnea. This individual has...

John Miller, a 65-year-old male, arrives at the clinic complaining of his shoes not fitting and...

John Miller, a 65-year-old male, arrives at the clinic complaining of his shoes not fitting and feeling like he cannot take a deep breath. During the patient interview, he also states that he is having intermittent pain in his chest. He is taking glyburide 2.5 mg daily, captopril 25 mg twice a day, and HCTZ 25 mg daily. He has not taken the HCTZ for 2 weeks and is hoping to get this medication refilled. The physician wants to evaluate...

A 50 year old male is seen in his physician’s office for a routine checkup. His...

A 50 year old male is seen in his physician’s office for a routine checkup. His spleen shows enlargement and his blood work shows hemolytic anemia with bilirubinemia. His wife states the patient has been “off” lately for no apparent reason. He tends to have muscle pulsations in the afternoon to late evening that do not stop until he goes to sleep. Additional blood work is ordered along with a type and screen. His haptoglobin levels are decreased, and his...

A 50-year-old male patient arrives in the emergency department complaining of severe chest pain. He is...

A 50-year-old male patient arrives in the emergency department complaining of severe chest pain. He is taken to the cardiac cath lab for a coronary angiogram and left ventriculogram. The cardiologist discovers a lesion in the left main coronary artery branch and orders an immediate CABG. 1. What does the acronym CABG stand for? 2. Why does the location of this lesion make it more dangerous than lesions in other locations? 3. Could the cardiologist perform an angioplasty to repair...

Description: John Miller, a 65-year-old male, arrives at the clinic complaining of his shoes not fitting...

Description: John Miller, a 65-year-old male, arrives at the clinic complaining of his shoes not fitting and feeling like he cannot take a deep breath. During the patient interview, he also states that he is having intermittent pain in his chest. He is taking glyburide 2.5 mg daily, captopril 25 mg twice a day, and HCTZ 25 mg daily. He has not taken the HCTZ for 2 weeks and is hoping to get this medication refilled. The physician wants to...

Bobby, a 72-year-old retired male went to his doctor, complaining of leg pain that started in...

Bobby, a 72-year-old retired male went to his doctor, complaining of leg pain that started in his lower back, ran across the side of his thigh and over the front of his knee. Next, he developed pain that radiated from his back to his front at the chest through the level of his nipples and also at the umbilicus. A physical and laboratory tests showed hard nodule on his prostate and an elevation in several of the blood tests. His...

A 50 year old male presents to the ER complaining of severe pain in his left...

A 50 year old male presents to the ER complaining of severe pain in his left toe. The pain was sudden in onset and he describes the pain as sharp and non radiating. He is having difficulty bearing weight on his foot. His past medical history is significant for essential hypertension which is well controlled with an Ace inhibitor. Examination is significant for an inflamed first metatarsal phalangeal joint. In passing, he states that he enjoys a good meal, like...

Question