Question

Admission date. January 29, 2019

57 year old male admitted from ER C/O nausea and vomiting, abdominal pain radiating to the right upper quadrant. Sclera icteric. Abdomen firmly distended with spider veins, skin shiny. The patient reports black stools.

DX: Cirrhosis, ETOH abuse, bleeding esophageal varices.

Labs:

Na 120 mEq/L

K 4.7mEq/L

Cl 87mEq/L

BUN 13 mg/dl

Creatinine 1.6 mg/dl

PTT 43 seconds (reference 23.7-32.7 seconds)

RBC 2.88 X 10mm

Hgb 9.1 g/dl

Hct 26.9%

Albumin 2.3 g/dl

Please explain the rationale for ALL abnormal lab values

Very briefly, explain the cause of each symptom.

Admission da "mission date January 29, 2019 Dain teen old male admitted from ERCc/o Nausea + vomitie, abden radiating to the right upper quadrant - Sclera ictent. - Sirmly distended with spider veuns, skin shing, the patrend Dx Cirrhosis, ETOH abuse, bleeduta esophagael varices. Abdomen repnts sirmly black du sholso habs NA 120 meg K 4-7 meg al 87 meg Bun sing creatmine 1.6 PTT 43 second (Reference 28-7-32-7 Seconds) RBC 2.88X10 Hab qol Het 26.9% Albumin 2.3 O please explaus the

Answer 1

In liver cirrhosis, scarring of hepatocyte (normal liver cells) occur, leads to malfunctioning of the liver. The main cause for liver cirrhosis is chronic alcoholism

Parameters	Normal Value	Patient Value	Reason for abnormal value
Na	136-145 meq/L	120 mEq/L	Normal function of the kidney will be impaired in Liver Cirrhosis, that causes decreased elimination of water and fluid retention, causes dilutional hyponatremia (Decreased sodium level). Patient also complaints of vomiting, leads to fluid loss and decreased sodium level
K	3.5-5.0 meq/L	4.7mEq/L	Normal range
Cl	98-106 meq/L	87mEq/L	Decreased chloride level sometime accomplished with Hyponatremia Decreased chloride is also due to fluid loss through vomiting
BUN	8-20 mg/dL	13 mg/dl	Normal range
Creatinine	0.7-1.3 mg/dL	1.6 mg/dl	Kidney is an organ which eliminates excess serum creatinine from the body. when its function is impaired due to liver cirrhosis, there will be elevation pf serum creatinine level
PTT	11-13 s	43 seconds (reference 23.7-32.7 seconds)	Almost all the blood clotting factors are synthesized in the liver. Damage to the liver (Cirrhosis), cause prolonged PPT time (bleeding) due to decreased synthesis in clotting factor
RBC	4.2-5.9 × 106/µL	2.88 X 10mm	Decreased RBC is due to bleeding. And also due to decreased synthesis of erythropoeitin (an enzyme promotes the synthesis of RBC) by the impaired kidney
Hgb	14-17 g/dL	9.1 g/dl	Decreased Hb level also due to bleeding.
Hct	41%-51%	26.9%	Hematocrite = number of RBC x MCV (mean corpuscular volume ). Since RBC level is already decreased, Hct level automatically will be less.
Albumin	3.5-5.5 g/dL	2.3 g/dl	Albumin is a plasma protein synrhesized fro the liver. Damaged (Cirrhotic) liver can not synthesis enough albumin, hence, its level will be reduced.

Symptoms	Its causes
Nausea and vomiting	Liver eliminates most of the toxins from body through the stool. Damage to the liver causes accumulation of waste product in the body causes nausea and vomiting.
Abdominal pain	Scarring of the hepatic cells, high pressure to portal vein, ascitis all leades to abdominal pain in liver cirrhosis
Sclera icteric	Yellowish color in the eye is sclera icteric. In liver cirrhosis, there is a elevation of bilirubin level in the blood, This elevated bilirubin can accumulates in the sclera of the eyes, because scleral cells have more affinity towards bilirubin. Hence Sclera icteric
Abdomen firmly distended with spider veins, and skin shiny	In patient with liver cirrhosis, there will be fluid accumulation in the peritoneal cavity known as ascitis. This can leads to distended abdomen and spider veins and shiny skin
Black stool	Oesophageal bleeding can cause blood in stool hence, black stool