chbare Posted June 12, 2009 Author Posted June 12, 2009 Guess #1) Hemochromatosis. A build up of iron causing the S/S the pt has. Is he jaundiced? How would you go about ruling this in or out? Take care, chbare. I haven't read through all of the posts so forgive me if I repeat anything. Tell us a little more about this palpable mass in the RUQ. Is there any hepatomegaly? Do we have access to a portable US? If so what do we see in the RUQ? Any diarrhea or wt loss? Let's send stool for ova and parasites. Is his brother here also? He does not have a mass. It is in fact generalized hepatomegaly. No US capabilities, no diarrhea, O&P is negative. His brother is back in the States. You cannot get ahold of him; however, I almost guarantee you will get through as soon as we have a diagnosis. I bet he will confirm it by having the same problem. Take care, chbare.
joesph Posted June 12, 2009 Posted June 12, 2009 (edited) OK AST is elevated still haven't pinned it down Muscular Distrohpy could be a player but the abdominal pain doesn't fit. Still a work in progress but given that if he still remains stable set him up for that 72 hr transport and monitor him. Oh yeah that LFP was a liver function panel my bad but I think we got there. Edited June 12, 2009 by joesph
Katiebug Posted June 12, 2009 Posted June 12, 2009 (edited) How would you go about ruling this in or out? Take care, chbare. I don't know. I only know about hemochromatosis because I read about it while looking up something else. I remember that it is a liver disorder, it causes abdominal pain, joint pain, bowel problems and decreased sexual function. Oh, and it runs in families, so if his brother has it too, it's a good indicator. It sticks out in my mind because the remedy is blood letting and replacing fluids until the Fe is back to normal levels. I suppose I would ask the pt if he has had a loss of sexual function/desire since the onset. Also if he remembers any of his brother's tx. Has he had any testicular issues? Is he jaudiced? Is his stool abnormaly dark? What else will excess iron cause? What about the whites of his eyes? Are they white? Edited June 12, 2009 by Katiebug
chbare Posted June 12, 2009 Author Posted June 12, 2009 I don't know. I only know about hemochromatosis because I read about it while looking up something else. I remember that it is a liver disorder, it causes abdominal pain, joint pain, bowel problems and decreased sexual function. Oh, and it runs in families, so if his brother has it too, it's a good indicator. It sticks out in my mind because the remedy is blood letting and replacing fluids until the Fe is back to normal levels. I suppose I would ask the pt if he has had a loss of sexual function/desire since the onset. Also if he remembers any of his brother's tx. Has he had any testicular issues? Is he jaudiced? Is his stool abnormaly dark? What else will excess iron cause? What about the whites of his eyes? Are they white? You are on the right track. Let's say we get ahold of his brother and his brother has hemochromatosis. With that additional bit of information, what tests could you order? In addition, do you think you have enough information to evac this guy out of country? Take care, chbare.
Katiebug Posted June 14, 2009 Posted June 14, 2009 Well, I've pretty much told you all I know about it. I'd have to google to do much more. We would have to test the blood Fe content. The only other assessment questions I can think of have already been listed. If Fe was elevated, yeah, I'd get him out of there and hope it was the right thing to do.
chbare Posted June 14, 2009 Author Posted June 14, 2009 Not a problem, this is tricky, as measuring serum iron will actually not be very useful. A few tests to consider;Transferrin saturation, Serum ferritin level, and genetic testing. (The first two are not definitive, as other condition can cause elevations.) A liver biopsy may be performed as well. With the family history, this is most likely an inherited form of hemochromatosis. I think you would be safe to evac this guy after noting the elevated LFT's. This is an adaptation of a scenario I experience while overseas. Fortunately, for me the patient reported that his brother had similar symptoms a few years earlier. After minimal investigating, we pretty much knew the problem without tests. However, I drew blood and sent off for labs. Unfortunately, the blood had to go to Pakistan and it took about two weeks for results. The patient refused evac but agreed to follow up with his PCP in the USA when he went on leave three weeks later. He went home with the results and was officially diagnosed with the disorder. Weekly phlebotomy was ordered with follow up testing. The patient refused to stay home and returned to the sand box. Unfortunately, blood collection equipment was not readily available; however, the patient had some local friends of his acquire several months worth of collection bags. How and where I do not know, nor do I want to know. Obviously, sex, age, and actual demographics may be different in order to preserve patient privacy. Hope you guys enjoyed this scenario. Strong work. Take care, chbare.
Recommended Posts