BONG

Marla Tecia P. Acapulco

Mariane Kimberly T. Ancajas
Jonnel Barnayha
Pardeep Singh V. Basi
Joanne Carol K. Chan
Eufeen Encarnacion
Catrina Mae C. Esplanada
Queenie C. Ferrolino
Teresa Mae C. Ocampo
Mary Rose P. Omolon
Silvino Rey H. Pino
Jose Wildon R. Roble
Ivy Sharon B. Roma

BONG

A 28-year old alcoholic appears to be perfectly healthy. Being alcoholic, he usually consumes more than his threshold level so that
he always ends up intoxicated and fully saturated. He in fact has to drink bottles of beer or shots of brandy at night for him to get a
well night sleep. One day, Bong had to go with his college friends and spend nights in Boracay to divert his attention about his
recent break up with girlfriend. He dived, bathes in the white sand and attended water sports. On the 2 nd night just before going to
a resort party, Bong and his boys went to an eat-all-you-can dinner filling their stomachs to fullest in preparation for a night fun of
tequila. He had to choose roasted pork and sweet and sour pork for his platter. As they consumed shots of tequila, Bong sat down
and watched his friends on the floor while enjoying the loud music in the club. He starts to feel intermittent abdominal pain which
at times severe that he had to double over to temporarily get rid of contracting pain. He observed that the pain rooted from the
upper left side of the abdomen and felt every after taking shots of alcohol. He journey back to hotel and rested early since he can
no longer withstand pain. In bed, the discomfort became much worse when he was lying on his back and radiated to his left
shoulder blade. The following day, he noticed passing out clay colored stools and fears the yellowish development in his skin. At
this day, pain from the abdominal area is much even worse than the night. He started to feel weak, feverish and was sweating
profusely that made him decide to interrupt his vacation for medical advice. In the ER of the following night (After the 2 nd night of
abdominal pain onset), the physician did physical examination and noted hypovolemia, rapid heart and respiratory rate plus high
grades fever. The physician issued stat laboratory studies and results are as follows:
HEMATOLOGY:
Complete Blood Count
RBC count: 3.9x1012/L
WBC count: 13x109/L
Hemoglobin: 15 g/dl
Hematocrit: 0.55 L/L
Platelet count: 101x103/L

CHEMISTRY:
AST: 26 U/L
ALT: 46 U/L
Amylase: 119 U/L
Lipase: 568 U/L
Calcium: 1.2 mEq/L
OTHER TESTS:
ESR: 21 mm/hr
Coagulation

PT: 46 seconds
APTT: 1 minute 13 seconds
FDP: 28 mg/dl
Serology
CRP: >200 IU/L
Urinalysis
Glycosuria reported
Peripheral
smear
shows
1+
schistocytes

GUIDE QUESTIONS:

Explain the

1.
2.
3.
4.

What is your diagnosis?

What factors have contributed for Bong to develop this condition?
Is the serology report significant? In what way it contributes to the diagnosis?
What is the relevance of coagulation studies?

Intermittent abdominal pain rooted from upper left side of abdomen radiating to left shoulder

Alcoholism, high-fat diet, lack of sleep, ESR, CRP, lipase, platelet count, prolonged PT & APTT,
schistocyte in peripheral smear, glycosuria, clay-colored stool, and jaundice

5.
relevance

FDP, +1

peripheral smear of Bong.

Alcohol-induced liver
injury: Alcoholic fatty liver

DIC secondary to Acute

Pancreatitis

-slight AST, ALT & GGT

-fatty infiltrates in liver
biopsy
-hypertriglyceridemia
-hypercholesterolemia
-hyperbilirubinemia
-hypoalbuminemia and
coagulopathy in
advanced liver injury

-hypovolemia
- FDP
-hypocalcemia
-prolonged PT & APTT
- amylase
-schistocytes in peripheral
smear
- lipase
-glycosuria
- platelet count
-acute edema in
retroperitoneal space
-leukocytosis
-hematocrit>44%
-azotemia
-hypertriglyceridemia
-hyperbilirubunemia -hypglycemia

Acute
Cholecystitis
-jaundice
-clay colored stools
-low grade fever
-leukocytosis
-mildly elevated
serum bilirubin
-elevated serum
aminotransferases

Alcohol consumption increases pancreatic exocrine secretion and has direct toxic effect on acinar cells which leades to
membrane damage. Hemostatic abnormalities may be related to early intravascular consumption of coagulation factors
secondary to circulating pancreatic enzymes, particularly trypsin.
-to alleviate
-analgesic
abdominal
for pain
pain
-to maintain
-IV fluids
normal
and
intravascular
volume colloids

of