Liver enlargement

yesterday we were confronted with a patient with the following complains

60 yo man,married,ex smoker, smoked for 35 years

c/o: rt hypochonrium pain, 4 years ago, present all the time, it was stitching pain gradually increasing by time, unrelated to food intake, radiate to both should, aggraveted by lying on his right side and by inspiration, and disappeared during expiration. after 1 y he complains the dyspnea, cough with sputum.
constipation: since 1.5 years. dark brown
urine: tea colored urine

loss weight as much as 10 kg over the past 1.5 years. no fever

( i wanted to analyse the dyspnea and cough but my colleagues ‘assumed’ that it wasnt dyspnea but rather due to the diseased liver. i hesitated this assumption . however since we were running out of time, i didnt analyse further. it turns out that the patient has bronchial carcinoma . so the lesson learnt here , its a mistake to assume a patients complaint and exclude it without analysing. such details may lead us to important findings)

how to dd tea colored urine due to hematuria or presence of bile without lab investigation?
leave the urine in a container for some time and in hematuria, there will be sediments of RBC at the bottom.

if you see a jaundice patient DONT FORGET TO ASK/FIND ABOUT
urine and stool
spider angioma
evidence of hemolysis
PRURITIS!!!!!!!(obstructive jaundice)
alcohol intake!!!!!
blood transfusion!!!!!!(source of hepatitis/ mismatched blood)

i was always told that hyperestrogenemia is due to failure of metabolism of estrogen due to the impaired liver function. both can be correct i guess?

postive findings: enlarged liver and spleen. State the span of the organs!

during palpation the first thing you have to notice or note at is the tenderness!! look at your patients in the eye!!!

alkaline phosphatase

In humans, alkaline phosphatase is present in all tissues throughout the entire body, but is particularly concentrated in liver, bile duct, kidney, bone, and the placenta

High ALP levels can show that the bile ducts are blocked.[11] Levels are significantly higher in children and pregnant women. Also, elevated ALP indicates that there could be active bone formation occurring as ALP is a byproduct of osteoblast activity (such as the case in Paget’s disease of bone)

Placental alkaline phosphatase is elevated in seminomas[12] and active form of Rickets.-wiki

in this patient, hi level suggests obstruction in the biliary ducts. do GGT to know the source of the hi ALP.

The main value of GGT over ALP is in verifying that ALP elevations are, in fact, due to biliary disease; ALP can also be increased in certain bone diseases, but GGT is not. – wiki source

pssst: Aldactone can also cause gynecomastia!!!!

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