The Case of Brenda Brown

(12 marks)

1. What message was passed to stop the local food epidemic?

Dr. Tom Fisher, the chairman of the local Physicians’ Association, gave a message over
the radio and at local schools was to “be meticulous in personal hygiene and cleanliness
of food preparation.

2. Why was Brenda almost misdiagnosed? Hint: consider your answer to #1.
Brenda was misdiagnosed because Dr. Fisher had seen many patients that day with
similar symptoms to Brenda’s condition. Brenda story and symptoms were similar to the
E. Coli patients Dr. Fisher had treated all day. She was pale and sweaty, and she hadn’t
felt well all day including tummy pains. The doctor had originally thought Brenda was
suffering the same condition as the other patients that day but since she hadn’t been in
town the doctor then thought she may have appendicitis since she hadn’t had surgery
before and would explain her symptoms of nausea, pain, and loss of appetite.

3. What is stored in the gall bladder and what function does it serve? (2 marks)
Bile, produced by the liver is stored in the gallbladder. The gallbladder releases the bile
when fats come down from the stomach. Bile contains strong brown pigments including
bilirubin which is the most important.

4. What is jaundice?
Jaundice is small solid lumps called gallstones crystalize out of bile which can end up
going down the bile duct. Gallstones can block the normal flow of bile into the
duodenum when they go down the bile duct. The blockage caused brown pigments to
accumulate in the blood stream this causes Jaundice. Jaundice causes skin and whites of
the eyes to be stained yellowish and the skin becomes itchy as well as the brown
pigments showing up in the urine.

5. Briefly explain each possible cause of jaundice below (4).

a) Obstructive jaundice – Occurs when gallstones block the normal flow of blood
and brown pigments accumulate in the blood

b) Infectious hepatitis – Transmitted through feces, found in poor sanitation

situations
c) Serum hepatitis – Transmitted by direct contact between blood from one
individual to another
Ex. Syringe

d) Toxic hepatitis – Caused by poisoning that can be introduced by either the mouth
or lungs.
Ex. Chemicals such as phosphorus and carbon tetrachloride
6. What was the third diagnosis? What test results confirmed this one? (2 marks)
Before Brenda’s surgery to remove her appendix, they took blood tests as well as a urine
test as they typically would before surgery. Brown urine is not associated with
appendicitis, so the technicians did a bilirubin test. This test confirmed that Brenda had
Jaundice not appendicitis. The Doctor re-examined her and noticed other signs of
jaundice as well such as yellowish eye whites but her healthy tan hid the yellowish
stained skin. The doctor had also recalled her scratching her hands when he first
examined her but mistook it for nervousness. She confirmed they itched along with her
feet. The doctor asked more questions and concluded that she must have been caused by
toxic hepatitis.

7. What was the long term change that Brenda had to make?
After having x-rays and more blood tests and her gallbladder and gallstones removed
Brenda has to avoid fat rich foods. Without her gallbladder to store bile in, her body is
unable to digest fatty foods without the bile.