Patient History the Patient's Medical History Involved essay

Download this essay in word format (.doc)

Note: Sample below may appear distorted but all corresponding word document files contain proper formatting

Excerpt from essay:

Patient History

The patient's medical history involved a resected colorectal carcinoma at the age of 60, with no evidence of metastatic disease. Liver function was normal at the time of surgery. Three years later, the female patient was found to have serum bilirubin levels of 20 ?mol/L. The serum levels for aspartate aminotransferase (AST) and alkaline phosphatase (ALP) were 23 U/L and 820 U/L, respectively.

Interpretation of the Laboratory Tests

High serum levels of ALP can indicate the presence of disease in the liver, bone, intestinal tract, and/or parathyroid, but the most common use for this assay is to detect disease of the hepatobiliary tract (Tietz, 1999, p 676). This is because the liver will respond to any obstruction in the biliary tree by producing more ALP, and these levels can be especially high if the blockage is extrahepatic (> 3 times the upper limit of the normal range). The normal range for women between the ages of 61 and 65 is 50-130 U/L, which is the age of the patient at the time of the most recent test. The patient's serum ALP levels are therefore 6-fold higher than the upper limit of the normal range. This level of ALP is consistent with a number of diseases and conditions, including extrahepatic obstructions like stones or a tumor of the pancreas head, or osteogenic bone cancer. The patient's ALP levels are not consistent with Paget's disease, because this condition tends to produce serum levels reaching 10 to 25 times the normal upper limit (Tietz, 1999, p. 677). The presence of disease affecting hepatocytes is unlikely given how high the ALP levels are, but this possibility can't be eliminated using this test alone. The sources of serum ALP can also be discriminated to some extent through laboratory testing, because different ALP isoenzymes are produced by the liver, bone, and placenta. This test can help discriminate between liver or bone diseases, including malignancies, or ectopic expression of the placental form (Regan isoenzyme) by other malignancies.

Assuming the bilirubin assay results are for total bilirubin, then the patients serum levels are slightly elevated (17%). The upper limit of the normal range for adult females is 17.1 ?mol/L (Tietz, 1999, p. 1170), so a serum level of 20 ?mol/L in an adult female would represent mild hyperbilirubinemia insufficient to cause the symptoms of jaundice (Tietz, 1999, p. 1158). The evaluation of total bilirubin serum levels is normally performed to assess liver function, but can also be used to evaluate diseases and treatments affecting the various stages of bilirubin production, metabolism, and excretion. In healthy individuals, bilirubin is extracted from senescent red blood cells by the liver, where it is conjugated with glucuronic acid for excretion in the bile (Tietz, 1999, p. 1135). Hemolysis or ineffective erythropoiesis represent prehepatic causes of hyperbilirubinemia, producing unconjugated bilirubin, otherwise any number of intrahepatic or post-hepatic diseases and conditions that affect liver or biliary function can elevate conjugated bilirubin serum levels as well (Jones, 2001). Together with the high serum levels of ALP, the mild hyperbilirubinemia could indicate a problem with the hepatobiliary system, but is otherwise not very useful diagnostically.

The patient's serum levels of AST (23 U/L) are well within the normal range for this enzyme (8-43 U/L; Jones, 2005). This test is typically used to assess liver function and represents one of two markers that can indicate the presence of liver disease. The other enzyme frequently used to assess liver function is alanine aminotransferase (ALT), which is a more specific and longer lasting marker for diseases affecting the cellular integrity of hepatocytes. In mild hepatocellular disease, the cytosolic forms of ALT and AST are released and the ALT/AST ratio is typically close to, or above, unity (Tietz, 1999, p. 653). If the liver disease is severe enough to cause hepatocyte necrosis, then the ALT/AST ratio is depressed due to the additional release of the mitochondrial isoenzyme of AST. Both AST and ALT can become elevated before clinical signs or symptoms of disease have manifested, and are therefore a preferred method for assessing hepatocyte health. In contrast to ALT, which is specific to hepatocytes, AST is also stored at high concentrations in the heart, skeletal muscle, and kidneys, and is therefore less liver-specific than ALT. The fact that…[continue]

Some Sources Used in Document:


Cite This Essay:

"Patient History The Patient's Medical History Involved" (2011, March 05) Retrieved December 6, 2016, from

"Patient History The Patient's Medical History Involved" 05 March 2011. Web.6 December. 2016. <>

"Patient History The Patient's Medical History Involved", 05 March 2011, Accessed.6 December. 2016,

Other Documents Pertaining To This Topic

  • Patient Noncompliance in Patients Advanced

    These studies demonstrate that there are several factors associated with patient noncompliance, regardless of the disease being treated. Medication side effects represent only one of these issues. Nurse practitioners could help to resolve many of these issues by being proactive and asking questions about side effects in patients at risk for becoming noncompliant. They may also be able to predict noncompliance in patients that are prescribed medications with known side

  • Patient Centered Medical Homes

    Patient Centered Medical Homes (PCMH) are often confused as being actual "homes" for patients to be admitted in and given medical treatment and care. PCMH is actually a health care model based on which health care is provided to patients, under the supervision of physicians. The PCMH model of health care provides patients with continuous, comprehensive medical care, in order to increase the chances of achieving the goal of benefitting

  • Medical Records System Definition of

    The master patient index (MPI) value was mainly liked by the personnel in the medical record section. The Golden 90s Equipped with MPI and record-keeping growth, software designers sustained to generate and progress with a new emphasis on individual hospital sections. Auxiliary department purposes, for example radiology and laboratory showed to be fairly adaptive to software that is fresh and innovative, and computer healthcare applications start to show on the market.

  • Patient Histories Can Often Provide a Great

    Patient histories can often provide a great deal of information about their condition and what the underlying causes may be. As such, taking an accurate patient history can be one of the most important aspects of a patient's visit to a medical facility. There are a number of factors that are important with respect to taking a patient's history, and they include one's ability to gain accurate information, one's

  • Medical Records

    EMR Electronic Medical Records Electronic Medical Record (EMR) keeping can definitely add efficiency into the modern healthcare system. However, this efficiency might be associated with some hidden costs. One example of such a cost will be due to the loss of privacy that is allowed by shared records. Not only will doctors be able to see your entire medical history, but other agencies that you might not want to share information with

  • Patient s History Involves More Than

    Another way to put the patient at ease during moments like this is for the nurse to be absolutely certain that she is not showing any signs of being judgmental. If this happens, it could throw the patient off guard and create an uncomfortable situation where the patient no longer feels comfortable being honest with the nurse. Once this happens, the nurse will have an inaccurate patient history and

  • Patient Diversity

    Health-Related Interactions: The cases of Todd vs. Mr. Gomez When dealing with a situation in which communications between a patient and a physician is difficult -- for example, if the patient has limited English proficiency or is deaf -- inevitably barriers are created which prevent a fully patient-centered communications process. Physicians often cite limited time as a reason for being insufficiently patient-focused. In the case study of Todd, the interaction was

Read Full Essay
Copyright 2016 . All Rights Reserved