Medical history 36-year-old male patient started cramp-type pain in lower abdomen and in both legs two days ago. Known sickle cell anaemia patient with multiple red cells transfusion in the past, also had a recent diagnosis of fibrous chronic liver disease. Denies alcohol consumption nor familial liver diseases. Diagnosis of sickle cell pain crisis is made and patient is hospitalized for laboratorial review and imaging study to better elucidate the liver disease aetiology. Magnetic resonance imaging (MRI) of the upper abdomen, axial view at L2 level, T2-weighted.Laboratorial review with results and normal ranges. Hemácias = red cells; hemoglobina = haemoglobin; hematócrito = haematocrit; plaquetas = platelets; AST = aspartate aminotransferase; ALT = alanine aminotransferase; FA = alkaline phosphatase; GGT = gamma glutamyltransferase; bilirrubinas totais = total bilirubin; sorologias hepatites virais = viral hepatitis serology; autoanticorpos = autoantibodies; gamaglobulina = gamma globulin; ferritina = ferritin; ferro sérico = serum iron; IST = transferrin saturation index; ceruloplasmina = ceruloplasmin; cobre urinário = urinary copper; bilirrubina indireta = indirect bilirubin. Question:Considering the clinical data, the laboratorial panel and the images, the most likely aetiology is: Wilson disease Secondary hemochromatosis. Non-alcoholic fatty liver disease Autoimmune hepatitis Question (2014 – UFG – Emergency Medicine - Adapted) Analyse the following clinical cases: 1. 15-year-old female with mild elevation of transaminases and ANA positivity. 2. 56-year-old male, diabetic, dark skin, family history of cirrhosis. 3. 35-year-old male, ulcerative rectocolitis and GGT and PA alterations, also mild transaminases alteration. 4. 32-year-old male with dysarthria, spasticity, low platelets and Kayser-Fleischer rings. The diagnosis of these clinical cases are, respectively: Wilson disease, hemochromatosis, primary biliary cirrhosis and sclerosing cholangitis. Autoimmune hepatitis, hemochromatosis, sclerosing cholangitis and Wilson disease. Viral hepatitis, Wilson disease, primary biliary cirrhosis and alcoholic hepatitis. Primary biliary cholangitis, non-alcoholic fatty liver disease, alcoholic hepatopathy and Wilson disease. Time is Up! Time's up
