Practice GI cases

Question 1

Faecal calprotectin - over reference by 5ug/g

CRP - 43mg/L over reference

Answer 1

Faecal calprotectin is normal, but there is obvious signs of inflammation - further testing required

Symptoms of IBD/IBS with diagnostic uncertainty

Question 2

CASE 2
Bilirubin - raised 16umol/L over ref. range
ALT - Raised 9x max of ref. range 
ALP - within ref. range 
Albumin -within ref- range

Answer 2

ALT disproportional increase in comparison to ALP suggest hepatocellular injury
- supported by raised bilirubin

Question 3

CASE 2 - one week later
(recap- last week showed increased ALP and bilirubin)
Now
Bilirubin increased even more 10x ref. max
ALT - 7x ref max
ALP- slightly above reference max
Albumin - within range

Answer 3

Points towards acute hepatitis as the ALT after a week has decreased around 200 U/L

Question 4

Case 3
Pale stools
Bilirubin - 10x max ref
ALT - within range 
ALP - 8x max ref
Albumin - normal

Answer 4

Cholestasis - bile retention due to blockage. Indicated by disproportional increase in ALP in comparison to ALT