Surg. 2 – Tutorial Lab result interpretation M K ALAM

The patient has marked tenderness in right iliac fossa. Blood result from a patient presented with right iliac fossa pain, vomiting and fever. The patient has marked tenderness in right iliac fossa. WBC - 16.2 X 10³/ mm³ (4-11 X 10³/ mm³) Neutrophil- 8.2 X 10³/ mm³ (2-7.5 X 10³/ mm³) Lymphocytes 1.53 X 10³/ mm³ (1.5-4 X 10³/ mm³) Monocytes 0.2 X 10³/ mm³ (0.2-.8 X 10³/ mm³) Eosinophils 0.05 X 10³/ mm³ (0.04-0.4 X 10³/ mm³) Basophils 0.02 X 10³/ mm³ (0.01-0.1 X 10³/ mm³)

Preoperative blood test from a patient who was admitted for abdominal surgery. WBC - 6.2 X 10³/ mm³ (4-11 X 10³/ mm³) Haemoglobin 13.2 g/dl (13-18 g/dl) Platelets 56 X 10⁹/L (150-350 X 10⁹/L)

Blood test from a patient who presented with RUQ abdominal pain & passage of tea color urine.    Total bilirubin 76 mmol/L (< 17 mmol/L) Direct bilirubin 52 mmol/L (< 5 mmol/L) ALT (Alanine aminotransferase) 31 U/L (5-30 U/L) AST (Aspartate aminotransferase) 38 U/L (10-40 U/L) Alkaline phosphatase 215 U/L (25-120 U/L)

Blood results from a patient who presented with RUQ abdominal pain, fever, and passage of tea color urine. Investigation Result Reference range WBC 19.2 X 10³/ mm³ 4-11 X 10³/ mm³ Total bilirubin 76 μmol/L < 17 μmol/L Direct bilirubin 66 μmol/L < 5 μmol/L ALT (Alanine aminotransferase) 31 U/L 5-30 U/L AST (Aspartate aminotransferase) 40 U/L 10-40 U/L Alkaline phosphatase 251 U/L 25-120 U/L

Hemolytic jaundice: High circulating unconjugated (indirect) bilirubin + no bilirubin in urine+ normal liver enzyme level. Obstructive jaundice: High circulating conjugated (direct) bilirubin + high bilirubin and no urobilinogen in urine+ pale stool (no stercobilinogen)+ raised ALP + normal/ mild rise of liver enzyme level. Acute cholangitis: Obstructed bile duct (stone, tumors) Charcot’s triad :Abdominal pain + pyrexia + jaundice Reynolds pentad : C Triad +septic shock + disorientation

Blood results from a 45-year old male presented with severe upper abdominal pain of sudden onset. Total bilirubin 19 mmol/L (< 17 mmol/L) ALT (Alanine aminotransferase) 31 U/L (5-30 U/L) AST (Aspartate aminotransferase) 38 U/L (10-40 U/L) Alkaline phosphatase 215 U/L (25-120 U/L) Amylase 1120 U/L (<100 U/L GGT (Gamma-glutamyl transferase) 250 u/L (10-55 u/L)

Blood result from a patient 2 days post-abdominal surgery. He is on- NPO, nasogastric tube drainage and IV fluid. Investigation Result Reference range Urea 3.8 mmol/L 2.5- 6.6 mmol/L Creatinine 69 μmol/L 60-120 μmol/L Sodium 139 mmol/L 135-145 mmol/L Potassium 2.7 mmol/L 3.6-5.1 mmol/L Chloride 96 mmol/L 95-107 mmol/L

Hypokalemia K⁺ ˂ 3.5 mEq/L Aetiology: Vomiting, diarrhea, GI fistula, diuretics Weakness, flattening of T wave , arrhythmias in patients on digoxin. Treatment: IV K⁺ - for severe cases Oral K⁺- 60-80 mEq / day for milder cases

HCO₃- 30 mmol/L (23-28 mmol/L) pCO₂- 42 mmHg (36-44 mmHg) Blood test from a patient with repeated vomiting of undigested food. He has a long history of intermittent upper abdominal pain.   pH- 7.46 (7.36- 7.44) H⁺- 33 nmol/L (44-36 nml/L) HCO₃- 30 mmol/L (23-28 mmol/L) pCO₂- 42 mmHg (36-44 mmHg) pO₂- 95 mmHg (80- 100 mmHg)

Blood result from a patient 3-days post-abdominal surgery. He is NPO and receiving IV fluid. Investigation Result Reference range Urea 3.8 mmol/L 2.5- 6.6 mmol/L Creatinine 69 μmol/L 60-120 μmol/L Sodium 127 mmol/L 135-145 mmol/L Potassium 3.7 mmol/L 3.6-5.1 mmol/L Chloride 91 mmol/L 95-107 mmol/L

Hyponatremia ECF normal/high- commonest cause in surgical patients on excessive administration of 5% dextrose. SIADH (uncommon in surgical practice) Treatment: Reduce water intake ECF low- combined water and sodium deficiency due to diarrhoea, diuresis or adrenal insufficiency Treatment: Normal saline infusion

Hyponatremia Shift of water into brain cell- cerebral oedema Metabolic encephalopathy Na < 120 mmol/L Confusion, seizures and coma Rapid correction leads to demyelination Cautious administration of normal saline

Blood test result from a middle aged female complaining of polyuria. Investigation Result Reference range Blood sugar (Fasting) 5.2 mmol/L 3.6 – 5.8 mmol/L Urea 3.8 mmol/L 2.5- 6.6 mmol/L Creatinine 116 μmol/L 60-120 μmol/L Sodium 139 mmol/L 135-145 mmol/L Potassium 4.2 mmol/L 3.6-5.1 mmol/L Chloride 112 mmol/L 95-107 mmol/L Calcium 2.9 mmol/L 2.25 – 2.6 mmol/L

Hypercalcaemia Hyperparathyroidism- primary, secondary, tertiary Increased calcium absorption- vitamin D excess, sarcoidosis, lithium, Excessive mobilization from bone- bone metastasis, myeloma, immobilization Ectopic parathyroid like hormone- ca-bronchus, ca-breast

Blood results from a patient on heparin therapy for 24 hours for deep vein thrombosis (DVT). PT (Prothrombin time): 14 seconds (10.5-13.5 seconds) aPTT (Activated partial thromboplastin time): 32 seconds (20-30 seconds) INR (International normalized ratio) : 1.1 (1)

Blood results from a patient who has been admitted with upper GI bleeding due to oesophageal varices. PT (Prothrombin time): 23 seconds (10.5-13.5 seconds) aPTT (Activated partial thromboplastin time): 32 seconds (20-30 seconds) INR (International normalized ratio) : 2.1 (1)