Case 1
I will initiate a comprehensive investigation where I will combine historical data taking, physical tests, lever diagnostics test, liver histology, and imaging to assist me in establishing a precise diagnosis on the aged patient. The first approach will be isolating liver enzyme alteration and repeating the tests to confirm the results obtained from the patient. Elevated AST and ALT should be assessed repeatedly by a physician since the risk is associated with an increment in liver-related mortality ("Liver Test Interpretation - Approach to the Patient with Liver Disease: A Guide to Commonly Used Liver Tests," 2020). It is important to note that an elevated ALT and AST may result due to various factors such as during the third trimester of pregnancy and as a result of reneged on vigorous exercise. As a result of these factors, I will use a comprehensive investigation of the aged patient to determine the primary cause of liver disorders. I will carry out various tests, use historical test data, and recommend imaging that will assist me in her treatment.
Alteration level of the liver enzymes can be classified as mild, moderate, and severe. Hence, further testing is required to determine her liver severity level. If the test results show that the alteration level of her liver enzymes is less than 5 (mild), 5-10 (moderate), greater than 10 (severe). After diagnosing her liver severity level, the next thing I will do is to determine the pattern of enzymes elevation. Enzymes elevation level can be divided into three levels:
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Pattern predominantly indicating hepatocellular injury (↑ ALT/AST ± ↑ bilirubin)
Pattern predominately indicating cholestasis (↑ ALP +/− ↑ bilirubin)
Mixed reactions (↑ both ALT/AST and ALP)
Since her lever test showed that her ALT and AST fluctuate from average to 300s and Autoimmune markers indicate negative, it means further diagnostic on the aged patient. Conducting additional analysis on the patient will assist me in assessing liver functions. I will use older liver test data and imaging to assess her past level in comparison to the previous liver situation. Laboratory testing is an important aspect to consider when evaluating a patient suffering from autoimmune disease ("Liver Test Interpretation - Approach to the Patient with Liver Disease: A Guide to Commonly Used Liver Tests," 2020). The diagnosis result assists the physician in the diagnosis confirmation, estimating then severalty level of the disorder. Its assessment aid to prognosis can be used by a physician to follow the disease activity and severity. Autoimmunity occurs as a result of the loss of normal immune homeostasis, which means that the organism releases an abnormal response subject to its self-tissue. The test from this patient indicated that her autoimmune is negative; hence we can justify that she is suffering from this disorder. In the past year, doctors have conducted comprehensive research in the determination of why the immune system produces an organism that is against its host.
Examining the presence of this disorder is difficult. Hence, several laboratory tests need to be established since the patient has also indicated to be suffering from an abnormal liver condition ("Liver Test Interpretation - Approach to the Patient with Liver Disease: A Guide to Commonly Used Liver Tests," 2020). Multiple laboratory tests need to be conducted on her, complete blood count; acute phase and comprehensive metabolic panel need to be conducted on the patient to determine the root cause of these diseases, repeated laboratory test will assist me in determining an effective treatment technique to use on the patient. In analyzing our results, we will use a combination of Gamma Glutamyl Tran’s peptidase (GGT) an Alkaline Phosphate (ALP) to interpreted clinical data regarding the patient. If GGT >>ALP = alcohol, medications and if ALP >>GGT = bone disease, pregnancy. For our case scenario ALP >>GGT hence we can justify that she may be present or she may be suffering from bone disease.
Some of the parameters that one has to consider before conducting a further test, and diagnostic to the patient are age of the patient, presence of comorbid diseases such as diabetes, history of the patient regarding alcohol consumption, family genetic condition history and history of test and diagnosis of inflammatory disorders and finally history of other related autoimmune diseases such as presence of autoimmune hepatitis (AIH) to the patient. Refereeing to historical tests on the patient, it indicated a fluctuation in her ALT and AST from average to 300s, and she had been diagnosed with the presence of an autoimmune disorder ("What Are Common Symptoms of Autoimmune Disease?”, 2020). Since the historical test data is evident, a repeated test should be conducted on the patient in absence from medication, alcohol consumption, toxin use before the physician ordering extensive work upon the patient's condition. Noninvasive medical tests, imaging procedures will assist me extensively in determining ten common causes of mild elevation on the patient's liver enzymes. In case of no presence of a root cause to the elevated liver enzymes to the patient, I will recommend undivided attention to be paid to the patient.
Case 2
Hepatitis C is a disease caused as a result of liver inflammation, which can lead to severe liver damages. Hepatitis C virus is transmitted as a result of contaminated blood from an infected person to a healthy person ("Hepatitis C - Symptoms and causes", 2020). Mrs. Keppy has a high-risk factor of being infected with Hepatitis C virus since she is married to a man who was diagnosed with this severe infection. She can quickly get in contact with contaminated blood from her husband hence her chances of being infected with this virus is very high. Also, considering her age, then risk of infection is still high. Yes, Mrs. Keppy should be tested whether she may be infected with this virus, which may have contracted from the husband. In case of a positive result of this infection in her blood, appropriate treatment procedures should be initiated on her as early as possible. She should take a test since it has been discovered that more than half of people suffering from HCV do not indicate symptoms of this infection since Hepatitis C takes decades before its signs and symptoms can appear. As a result of this reason for the hidden traits of the disease, Mrs. Keppys should receive regular blood screening and testing since her chances of being infected with this virus are high. Regarding the treatment of her husband, Mr. Keppy should undertake weekly HCV injections and oral medications, despite the associated side effects and other health-related problems resulting from HCV medicating. Therefore, he should take the drug on weekly basis as prescribed by a physician.
References
Antinuclear Antibody Panel: Purpose, Results, and Risks. (2020). Retrieved 27 February 2020, from https://www.healthline.com/health/antinuclear-antibody-panel
What Are Common Symptoms of Autoimmune Disease? (2020). Retrieved 27 February 2020, from https://www.hopkinsmedicine.org/health/wellness-and-prevention/what-are-common-symptoms-of-autoimmune-disease
Liver Test Interpretation - Approach to the Patient with Liver Disease: A Guide to Commonly Used Liver Tests. (2020). Retrieved 27 February 2020, from http://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/hepatology/guide-to-common-liver-tests/
Lowth, D. (2020). Abnormal Liver Function Tests. Retry
ved 27 February 2020, from https://patient.info/digestive-health/abnormal-liver-function-tests-leaflet
Hepatitis C - Symptoms and causes. (2020). Retrieved 27 February 2020, from https://www.mayoclinic.org/diseases-conditions/hepatitis-c/symptoms-causes/syc-20354278
