Question 3 [10 marks] A 59 yr male presented to the ED with severe eipgastric pain. He has had similar pain on-and-off s

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Question 3 10 Marks A 59 Yr Male Presented To The Ed With Severe Eipgastric Pain He Has Had Similar Pain On And Off S 1 (75.62 KiB) Viewed 42 times

Question 3 [10 marks] A 59 yr male presented to the ED with severe eipgastric pain. He has had similar pain on-and-off since he was 18 yrs, but it had worsened significantly in the past few days sending him the ED. Clinical History. As a boy, he was healthy on a relatively low fat diet, however at 18 yrs he became a merchant sailor and began to experience abdominal pain. He described his diet as high in fat. At a routine check-up at 24yrs, his physician noted that his serum was "milky white" but his cholesterol was only 5.6 mmol/L (reference interval, <5.2 mmol/L). He continued to have epigastric pain. At 48 he was admitted to hospital for abdominal pain. His serum was lipemic with a cholesterol of 15.3 mmol/L and triglycerides of 106 mmol/L (reference interval <1.7 mmol/L). Further testing was done, including a post-heparin lipolytic activity measurement which was found to be absent (i.e. very low). The patient is a bachelor. His parents were second cousins. His siblings have normal or slightly elevated lipids, but do not have similar clinical complaints. Over the course of his hospitalization, his hemoglobin dropped and the patient was transfused with 2 units of whole blood. Interestingly, within 2 days of the transfusion, his triglycerides returned to normal and slowly increase back to their previous concentrations over the next 15 days. a. What is this patient's Fredrickson classification (type I, lla, IIb, III, IV, or V) and what lipid fraction(s) would you expected to be elevated? [2 marks] b. What is the cause of his epigastric (abdominal) pain and what is the underlying cause? What test could you use to confirm the diagnosis? [2 marks] c. Explain how the post-heparin lipolytic activity assay works and what it is being measuring. [3 marks] d. Why did the tryglycerides drop after the blood transfusion? Explain the mechanism and identify the cause of his lipid abnormalities. [3 marks]