Correct
2. No
Sickle cell trait is not associated with a higher risk of exercise-related death, but it is associated with a significantly higher risk of exertional rhabdomyolysis (3). Sickle cell trait occurs in about 8 percent of the U.S. African-American population and between 1 in 2,000 to 1 in 10,000 in the Caucasian population (4). Most U.S. states test at birth but many athletes are unaware that they have sickle cell trait. The NCAA recommends that athletics departments confirm sickle cell trait status and avoid dehydration, severe exercise with acute illness, and modify training at higher altitudes (4). There is no evidence that there is an association between sickle cell trait and exertional heatstroke (1).
Later in the patient’s hospital course, the patient continued to have elevated liver function tests as follow:
Two days after admission: AST 4644, ALT 2688, Alk phos 62, Total bili 5.9
Seven days after admission: AST 188, ALT 1440, Alk phos 85, Total bili 13.9, Direct bili 13.0
Ultrasound of the right upper quadrant showed gallbladder wall thickening with trace pericholecystic fluid equivocal for acute cholecystitis. HIDA scan showed complete obstruction at the distal common bile duct without evidence for cystic duct obstruction. CT abdomen/pelvis showed normal liver with patent portal vein, splenic vein and superior mesenteric vein. The gallbladder was normal with radiopaque gallstones. No intrahepatic or extrahepatic biliary dilatation was noted.
What is the best explanation and management in evaluating this patient’s abnormal liver function? (Click on the correct answer to be directed to the sixth and final page)