IPLab:Lab 12:Alcoholic Cirrhosis

From Pathology Education Instructional Resource
Jump to: navigation, search

Contents

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.

Images

Study Questions


Additional Resources

Reference

Journal Articles

Images

Related IPLab Cases