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Case 46-1963

1963; Massachusetts Medical Society; Volume: 269; Issue: 2 Linguagem: Inglês

10.1056/nejm196307112690210

1533-4406

John D. Stoeckle, Robert E. Scully,

Amino Acid Enzymes and Metabolism

Presentation of CaseA seventy-two-year-old man was referred to the hospital because of jaundice.Two months previously the patient experienced the onset of swelling of the abdomen, associated with anorexia, loss of weight and weakness. Three weeks before admission he became jaundiced and on several occasions passed clay-colored stools and dark urine; there was no abdominal pain, melena, hematemesis, chill, fever, fatty-food intolerance or dysuria. He had had no recent injections, exposure to toxins or contact with anyone with jaundice. He had ingested small amounts of alcohol for many years, but allegedly never drank excessively. Moderate constipation had occurred for . . .