Question

FORUM DESCRIPTION

Chris is a 52 year old male with chronic alcoholism. He typically drinks a bottle of vodka (one liter) per day. He was brought to the emergency room today with a distended abdomen, swollen legs and feet, extremely lethargic, and hematemesis. Over the past few days, he has become more and more confused and disoriented. He is jaundiced, and shows small spider-like tangles of blood vessels on his skin with pruritis.

Laboratory results showed the following:

TEST	RESULT	NORMAL VALUES
Hematocrit	25%	45-52%
Prothrombin time (coagulation)	17 seconds	11-16 seconds
Liver enzymes (ALT)	190 IU/L	10-40 IU/L
Direct bilirubin	4.8 mg/dL	<0.3 mg/dL
White blood cells	2000/mm3	4500-10000/mm3
Albumin	2.8 g/dL	3.2-4.5 g/dL
Thrombocytes	80000/mm3	150000-300000/mm3
Ammonia	70 μmol/L	6-47 μmol/L

1. Describe 1 major pathophysiological change that occurs in the liver for EACH stage of alcoholic liver disease (alcoholic fatty liver, alcoholic hepatitis, cirrhosis). (1.5 pts)

2. a) What is ascites? (0.5 pts)

     b) Explain 3 causes for the development of ascites in liver disease. (1.5 pts)

3. For each test listed in the table above, explain why the results would have occurred. (4 pts)

4. Explain why would someone with cirrhosis has problems obtaining sufficient amounts vitamins A, D, E, and K. (1 pt)  

5. Describe 3 factors that could be causing Chris’ confusion and disorientation. (1.5 pts)

Answer 1

1, cirrhosis of liver is a alcoholic liver disease caused by multifactorial..pathological includes degeration and necrosis of hepatocytes it replaced with liver parenchyma by fibrotic tissue and regenerative nodules and there is loss of liver function..

2, a, Ascites is the condition when there is abnormal fluid collection inside the abdomen usually caused by cirrhosis..

B, causes:

- Alcoholic liver cirrhosis when people drink long time, liver replaced with scar tissue..

- liver cancer

- hepatitis

3, - elevated liver enzymes due to damage to cells in the liver..

- low WBC count due to infection

- low Albumin level indicate poor liver function due to significant liver damage

- Thrombocytes decreased due to complication in chronic liver disease condition called thrombocytopenia..

- High Ammonia liver can change the consciousness can cause hepatic encephalopathy due to liver failure..

4, In chronic liver disease there is vitamin D,A,E and k deficiency due to lack of anti proliferative effects, and calcium hemostasis which is more important for vitamin D formation..cholestasis leads to less lipid absorption it reduce the energy uptake and made malabsorption..due to decreased absorption vitamin A, D, E,K will be less in amount..