nbme 17 ..please explain - ahmad12801

[ArchivalUser]

. A 45-year-old man comes to the physician because of yellow skin for 4 days. He lost his job 10 days ago, and he has been drinking eight to ten 12-ounce cans of beer daily since then. Physical exam shows jaundice. The liver is tender to palpation. Serum studies show:
Total bilirubin 5.9
Alk phos 210
AST 110
ALT 69
y-Glutamyltransferase 35 (N=0-30)
Histologic examination of a liver biopsy specimen will most likely show which of the following?
A) alpha1-antitrypsin globules
B) Glycogen
C) Hemosiderin
D) Lipofuscin
E) Mallory hyaline

[ArchivalUser]

is it E

[ArchivalUser]

E. ALD. Liver biopsy shows characteristic features of neutrophil infiltration, hepatocyte ballooning and Mallory bodies.

[ArchivalUser]

Ahmad,

One more thing to remember. GGT levels are increased in patients with ALD.

[ArchivalUser]

thanks onchology

[ArchivalUser]

What is ALD mean

[ArchivalUser]

ALD = Alcoholic Liver Disease

[ArchivalUser]

We should see macrovesicular fatty change (Hepatocytes filled with fat droplets) giving the case that this patient has been drinking for the last 10 days?

Doesn't Alcoholic Hepatitis (which would show Mallory bodies) requires sustained, long term consumption? Is 10 days considered long-term consumption?

TIA

[ArchivalUser]

@md97

I was thinking the same thing. 10 days is def not enough to be causing this level of alcoholic hepatitis!! wouldn't something like alpha1 antitrypsin deficiency predispose him to something like this?

[ArchivalUser]

He must have lost his job due to alcohol consumption during work. At times, NBME wants us to become Sherlock !