1. Surg. 2 – Tutorial Lab result interpretation
M K ALAM

2. 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 X 10³/ mm³ (4-11 X 10³/ mm³)
Neutrophil X 10³/ mm³ (2-7.5 X 10³/ mm³)
Lymphocytes 1.53 X 10³/ mm³ (1.5-4 X 10³/ mm³)
Monocytes X 10³/ mm³ ( X 10³/ mm³)
Eosinophils X 10³/ mm³ ( X 10³/ mm³)
Basophils X 10³/ mm³ ( X 10³/ mm³)

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

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

5. 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
U/L

6. 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

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

8. 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
mmol/L
Creatinine
69 μmol/L
μmol/L
Sodium
139 mmol/L
mmol/L
Potassium
2.7 mmol/L
mmol/L
Chloride
96 mmol/L
mmol/L

9. 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⁺ mEq / day for milder cases

10. 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 ( )
H⁺ nmol/L (44-36 nml/L)
HCO₃ mmol/L (23-28 mmol/L)
pCO₂ mmHg (36-44 mmHg)
pO₂ mmHg ( mmHg)

11. 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
mmol/L
Creatinine
69 μmol/L
μmol/L
Sodium
127 mmol/L
mmol/L
Potassium
3.7 mmol/L
mmol/L
Chloride
91 mmol/L
mmol/L

12. 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

13. 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

14. 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
mmol/L
Creatinine
116 μmol/L
μmol/L
Sodium
139 mmol/L
mmol/L
Potassium
4.2 mmol/L
mmol/L
Chloride
112 mmol/L
mmol/L
Calcium
2.9 mmol/L
2.25 – 2.6 mmol/L

15. 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

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

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