SEROLOGY Date: 9/8/2013 Test Creatinine

Analysis & Interpretation Normal no presence of any kidney impairment. AST/SGOT 28.0 17-59 u/L Normal - there is no presence of any hepatocellular injury related to a bile duct obstruction. ALT/SGPT 32.0 21-72 u/L Normal - There is no presence of any hepatocellular injury a bile duct obstruction. Alk Phosphatase 129.0 38-126 u/L Above normal elevation of alkaline phosphatase suggests a reduction in bile flow or an impediment of the bile flow which maybe resulted from an inflamed gallbladder. A serum alkaline phosphatase elevation out of proportion to the level of the aminotransferases suggests a cholestatic disorder which may cholecystitis or cholelithiasis. Total Bilirubin 8.50 3-22 umol/L Normal there is a normal excretion of bilirubin in the body. This may indicate that there is no presence of any significant bile duct obstruction. Direct Bilirubin 3.70 0-5 umol/L Normal - there is a normal excretion of direct bilirubin in the body. This may indicate that there is no presence of any significant bile duct obstruction. Bilirubin is conjugated with glucuronic acid by the enzyme glucuronyltransferase, making it soluble in water. Much of it goes into the bile and thus out into the small intestine. However, 95% of the secreted bile is reabsorbed by the liver. This bile is then resecreted by the liver into the small intestine. Indirect Bilirubin 4.80 0-19 umol/L Normal - there is a normal excretion of bilirubin in the body. This may indicate that there is no presence of any significant bile duct obstruction. This unconjugated bilirubin is not soluble in water, due to intramolecular hydrogen bonding. It is then bound to albumin and sent to the liver. Reference: Smith, E.Y., L.A. Charles, and E.M. Van Cott, Biphasic activated partial thromboplastin time

Result 65

Normal Value 58-110 umol/L

waveform and adverse events in non-intensive care unit patients. Am J Clin Pathol, 2004. 121(1): p. 13841.

COAGULATION AND HEMOSTASIS PRO Time Date: 9/8/2013 Test Result Prothrombin Time-Patient 12

Normal Value 10-14 sec

Prothrombin TimeControl

12

10-14 sec

Prothrombin TimeActivity

86.2

70-130

Prothrombin Time-NR

1.00

Analysis & Intepretation Normal - there were no deviations or abnormalities in the absorption of fatsoluble vitamins, including vitamin K, which is required for activation of certain coagulation factors. Findings are not expected to be elevated unless sepsis or underlying cirrhosis is present. Normal - there were no deviations or abnormalities in the absorption of fatsoluble vitamins, including vitamin K, which is required for activation of certain coagulation factors. This indicates that there was no presence of a hepatic injury involvement related to cholecystitis. Normal - there were no deviations or abnormalities in the absorption of fatsoluble vitamins, including vitamin K, which is required for activation of certain coagulation factors. This indicates that there was no presence of a hepatic injury involvement related to cholecystitis. Normal - there were no deviations or abnormalities in the absorption of fatsoluble vitamins, including vitamin K, which is required for activation of certain coagulation factors. This indicates that there was no presence of a hepatic injury involvement related to cholecystitis.

COAGULATION AND HEMOSTATSIS APT Date: 9/8/2013 Test Activated Partial Thromboplastin-Patient

Result 33

Normal Value 22-35 secs

Analysis & Intepretation Normal - The most common indications for ordering these tests include

anticoagulant monitoring, initial evaluation of hemorrhage, and, although not generally indicated, routine preoperative screening. Activated Partial 29 22-35 secs Normal - APTT Thromboplastin-Control (Activated Partial Thromboplastin Time) is the time in seconds for a specific clotting process to occur, in the laboratory test. This result is always compared to a control sample of normal blood. Reference: http://emedicine.medscape.com/article/2085837-overview#aw2aab6b3

UTZ Date: 9/7/2013 Test Ultrasound of the Hepatobiliary Tree

Results

Analysis and Interpretation

The liver is normal in size The CBD may dilate when exhibiting normal parenchymal obstructed by a stone, a mass, or chogencity. Multiple punctuate a stricture. The normal width of parenchymal calcification are seen the CBD is 4 mm. Older patients in the superior segments of the may have a normally dilated duct right liver lobe. The intra hepatic up to 1mm for every decade past ducts are not dilated. The the age of 40. The CBD may be proximal CBD is dilated measuring dilated up to 1cm normally after 0.69 cm. The distal CBD is obscure cholecystectomy. In the setting by bowel gas precluding adequate of acute cholecystitis, the evaluation. common hepatic duct may be dilated due to inflammation of the gallbladder wall neck and cystic duct causing external pressure.

The gallbladder exhibits diffusely The

gallbladder

showed

thickened walls (0.45cm in full thickness). Multiple echogenic foci with comet-tail artifacts are seen within walls. A curvilinear echogenic shadowing focus is seen within the gallbladder lumen measuring 1.65 cm. No pericholecystic fluid or sonographic Murphys sign.

significant thickening (>3mm or 0.3cm) which may indicate inflammation. The gallbladder wall may be thickened in many disease states. Acute cholecystis is the most common of these. Ascites and congestive heart failure are the second and third most common cause of gallbladder wall thickening. Hepatitis may also cause gallbladder wall edema. Gallbladder wall cancers may show a thickened and/or calcified gallbladder wall. There was no presence of any pericholecystic fluid which may which is indicative of actual or impending perforation of the gallbladder. Negative Murphys sign (pain on compression of the GB with the ultrasonographic probe).

The panceas as well as the spleen The pancreas is normal. No are unremarkable with no discrete indications of any affectation due focal lesions seen. The main to common bile duct obstruction. pancreatic duct is not dilated. The kidneys are normal in size, There was no presence of shape, and location. The right indicative affectations on the kidney measures 11.40 x 5.32 kidneys. x5.13 cm with a cortical thickness of 1.10 cm while the left kidney measures 10.80 x5.08x 5.31 cm with a cortical thickness of 1.11cm. Mild pelvocaliectasia is seen bilaterally. The cortices are normal in thickness and echogenicity. Reference: http://www.ajronline.org/doi/full/10.2214/AJR.05.1712 http://www.ajronline.org/doi/full/10.2214/AJR.07.3893