IPLab:Lab 12:Alcoholic Cirrhosis

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Clinical Summary

This 56-year-old white male came to the emergency room because of weakness, lack of appetite, shortness of breathShortness of breath is a common clinical manifestation of heart failure., abdominal distention, and an altered mental status. He was a known alcoholic who drank approximately one pint of whiskey per day. Physical examination revealed a wasted appearance, icterusHyperbilirubinemia making the patient appear yellow. Also called jaundice.Jaundice (or icterus) is a state of hyperbilirubinemia (increased bilirubin in the blood) in which bile pigment is deposited in the skin, mucous membranes, and scleras. This deposition of bile pigment results in a yellow appearance., a protuberant abdomen, bilateral gynecomastia, sparse axillary hair, and spider angiomataA focal network of small arteries and arterioles arranged in a radial pattern with a central red spot. on his chest. Liver and spleen were not palpable, the testes were atrophic, and the legs showed petechial hemorrhages and 3+ edema. Admission laboratory values revealed a hemoglobin of 9.5 g/dLNormal hemoglobin for a male is 14 to 17.2 gm/dL., an MCV of 106 fLThe normal mean corpuscular volume (MCV) is 83 to 99 fL., a platelet count of 97,000/mL, and a prothrombin time of 19.2 secondsA normal prothrombin time is 12.6 to 14.6 seconds.. In addition, his albumin was 2.3 g/dLThe normal albumin level 3.9 to 4.8 gram/dL., bilirubin, total 6.5 mg/dLA normal total bilirubin level is 0 to 1.0 mg/dL., AST 21.0 U/LA normal aspartate aminotransferase (AST) for a male is <37 U/L., ALT 56 U/LA normal alanine aminotransferase (ALT) is 7 to 56 U/L., alkaline phosphatase 180 U/LA normal alkaline phosphatase is 39 to 117 U/L., and GGT 320 U/LA normal gamma-glutamyl transpeptidase (GGT) is 0 to 65 U/L.. The patient was treated with thiamine, folate, multivitamins, and vitamin K and an intravenous line was placed to infuse 5% dextrose. An esophagogastroduodenoscopy (EGD) was performed which demonstrated large esophageal varices with evidence of previous bleeding sites. Two days after admission the patient developed a massive hematemesisHematemesis is the vomiting of blood. and his hematocrit dropped to 17%A normal hematocrit for a male is 39 to 49%.. Emergency EGD showed ruptured esophageal varices. Despite successful sclerotherapy and supportive transfusions, the patient lapsed into coma and died the next day.


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