Urinalysis Case Study

A 50 year old Native American female visits her primary care provider complaining of steady pain in her upper abdomen, nausea, vomiting, fever, and chills.  The doctor notices that there is a yellow tinge to the patient's skin and in the sclera of her eyes.  An ultrasound exam reveals the presence of gallstones; the patient also has a history of high cholesterol.
 
 

Urinalysis Results
The Biliary System
Specimen Pictures
Questions










Urinalysis Results:
 
 


Color:  Amber Protein:  Negative Blood:  Small
Appearance:  Hazy Glucose:  Negative Urobilinogen:  0.2 mg/dl
Specific Gravity:  1.015 Ketones:  Negative Nitrite:  Negative
pH:  5.0 Bilirubin:  Moderate Leukocyte:  Negative

             Microscopic:

             5-10 rbcs/hpf
             Bilirubin crystals
 
 

The Biliary System
 
 
 
 

Figure 1:  The gallbladder and the ducts that
carry bile and other digestive enzymes from
the liver, gallbladder, and pancreas to the small
intestine are called the biliary system.
(http://digestive.niddk.nih.gov/diseases/pubs/gallstones/index.htm)

 
 

Specimen Pictures
 
 

                                   Figure 2:  Picture from the fresh urine specimen.  Note the classically
shaped bilirubin crystal in the center of the photo.

 
 

Figure 3:  Picture from the same specimen after it has been sitting for
a couple of hours.  Note that there are more bilirubin crystals, this would
not be uncommon as these crystals form in the urine following excretion.
Also, note that the bilirubin crystals have lost their characteristic "spiky"
shape.

 
 

Questions

1)  What is the most likely diagnosis for this patient?

ANSWER


2)  What would you expect the color of this patient's stool to be and why?

ANSWER


3)  Why is there still a normal urobilinogen stix result?

ANSWER



4)  Does this patient have an increase in unconjugated or conjugated bilirubin in their blood?

ANSWER



5)  Why can conjugated bilirubin pass the glomerular filtration barrier, but unconjugated bilirubin cannot?

ANSWER