Question

question 7 (mandatory) (1 point)
a 29 - year - old male patient presents to your office with fatigue and malaise. he has right upper quadrant pain and an enlarged and tender liver. he has a history of chronic alcohol abuse and has recently been on a two - day bender (multiple day drinking spree) with little to no food or sustenance. his lab report shows elevated ast, alt, ggtp, alkaline phosphatase, and a decreased bun. what is the most likely diagnosis?
a) renal calculi
b) nephrotic syndrome
c) cholecystitis
d) diabetes
e) cirrhosis

Explanation:

• Renal calculi (kidney stones): Usually present with flank pain, hematuria (blood in urine), and may not directly cause the liver - related symptoms (elevated liver enzymes like AST, ALT, GGTP, alkaline phosphatase) and decreased BUN in the context of chronic alcohol abuse.
• Nephrotic syndrome: Characterized by massive proteinuria, hypoalbuminemia, edema, and hyperlipidemia. It does not typically present with right upper quadrant pain, an enlarged liver, or the pattern of liver - enzyme elevations seen here.
• Cholecystitis (inflammation of the gallbladder): Often presents with right upper quadrant pain that may radiate, but the chronic alcohol abuse history and the pattern of liver - enzyme elevations (AST, ALT, GGTP, alkaline phosphatase) along with decreased BUN (which can be due to liver dysfunction affecting protein metabolism) are more in line with a liver - related disorder rather than just gallbladder inflammation.
• Diabetes: Can present with fatigue, but the other symptoms (right upper quadrant pain, enlarged liver, specific liver - enzyme elevations) are not typical of diabetes.
• Cirrhosis: Chronic alcohol abuse is a major risk factor for cirrhosis. Symptoms such as fatigue, malaise, right upper quadrant pain (due to liver enlargement and possible stretching of Glisson's capsule), an enlarged and tender liver are common. In liver cirrhosis, liver cell damage leads to elevated liver enzymes (AST, ALT, GGTP, alkaline phosphatase). Decreased BUN can occur because the liver (which is involved in urea synthesis from ammonia) is damaged in cirrhosis, reducing its ability to produce urea.

Answer:

e) Cirrhosis