Answer 12
What is the strategy of thinking in this patient?
Discussions conducted by internal medicine residents:
-One opinion by dr. M.Hamza and dr. Ali
Abou Taleb:
"... one possibility is that it may
represent a liver injury by the drugs prescribed to relieve itching."
- I think this postulation should be
postponed till negating the other causes of priority.
Well, every case should be thought of
in its own context postponing other remote possibilities to the end of
the list, which applies here.
So the most logical thinking strategy
-in the order of priority- in this case is:
-Itching problem is not a separate one, rather it is an early
manifestation of hepatic affection revealed after labs were done.
-After confirming liver affection, starting from symptoms (itching,
right hypochondrial pain), ending with elevated enzymes, the most
logical thinking is excluding promptly the fatal causes of "pregnancy-induced
hepatic injury".
 |
-Other causes that may coincide with pregnancy should be also thought of
but should take the second rank in your intuition. Examples of such
causes: viral hepatitis, gallbladder disease, and the rest of diseases
affecting the liver mentioned in the literature. These disorders were
excluded first by the physician who was attending to the patient which
is a reverse to the strategy we're presenting here leaving the fatal
ones "unattended"!!
