Difference between revisions of "IPLab:Lab 12:Alcoholic Cirrhosis"

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== Clinical Summary ==
 
== Clinical Summary ==
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This 56-year-old white male came to the emergency room because of weakness, lack of appetite, shortness of breath, abdominal distention, and an altered mental status. He was a known to have alcohol use disorder and he drank approximately one pint of whiskey per day. Physical examination revealed a protuberant abdomen, bilateral gynecomastia, and spider angiomata on his chest. Liver enzymes were elevated, albumin was low and he was anemic. 
  
This 56-year-old white male came to the emergency room because of weakness, lack of appetite, shortness of breath, 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, icterus, a protuberant abdomen, bilateral gynecomastia, sparse axillary hair, and spider angiomata 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/dL, an MCV of 106 fL, a platelet count of 97,000/mL, and a prothrombin time of 19.2 seconds. In addition, his albumin was 2.3 g/dL, bilirubin, total 6.5 mg/dL, AST 21.0 U/L, ALT 56 U/L, alkaline phosphatase 180 U/L, and GGT 320 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 hematemesis and his hematocrit dropped to 17%. 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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The patient was given thiamine, folate, multivitamins, and vitamin K and an intravenous line was placed to infuse 5% dextrose. An esophagogastroduodenoscopy (EGD) demonstrated large esophageal varices. Two days after admission the patient developed a massive hematemesis due to rupture of an esophageal varices and despite successful sclerotherapy and supportive transfusions, the patient died the next day.
  
 
== Images ==
 
== Images ==
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=== Journal Articles ===
 
=== Journal Articles ===
 
* Fujimoto J.  [http://www.ncbi.nlm.nih.gov/pubmed/10759218 Gene therapy for liver cirrhosis].  ''J Gastroenterol Hepatol'' 2000 Mar;15 Suppl:D33-6.
 
* Fujimoto J.  [http://www.ncbi.nlm.nih.gov/pubmed/10759218 Gene therapy for liver cirrhosis].  ''J Gastroenterol Hepatol'' 2000 Mar;15 Suppl:D33-6.
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* Ge PS and Runyon BA  [http://www.nejm.org/doi/pdf/10.1056/NEJMra1504367 Treatment of Patients with Cirrhosis].  ''NEJM'' 2016 Aug 25 375(8):767.
  
 
=== Images ===
 
=== Images ===
* [http://peir.path.uab.edu/library/index.php?/tags/128-cirrhosis PEIR Digital Library: Cirrhosis Images]
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* [{{SERVER}}/library/index.php?/tags/128-cirrhosis PEIR Digital Library: Cirrhosis Images]
 
* [http://library.med.utah.edu/WebPath/LIVEHTML/LIVERIDX.html WebPath: Hepatic Pathology]
 
* [http://library.med.utah.edu/WebPath/LIVEHTML/LIVERIDX.html WebPath: Hepatic Pathology]
  

Latest revision as of 21:10, 9 July 2020

Clinical Summary[edit]

This 56-year-old white male came to the emergency room because of weakness, lack of appetite, shortness of breath, abdominal distention, and an altered mental status. He was a known to have alcohol use disorder and he drank approximately one pint of whiskey per day. Physical examination revealed a protuberant abdomen, bilateral gynecomastia, and spider angiomata on his chest. Liver enzymes were elevated, albumin was low and he was anemic.

The patient was given thiamine, folate, multivitamins, and vitamin K and an intravenous line was placed to infuse 5% dextrose. An esophagogastroduodenoscopy (EGD) demonstrated large esophageal varices. Two days after admission the patient developed a massive hematemesis due to rupture of an esophageal varices and despite successful sclerotherapy and supportive transfusions, the patient died the next day.

Images[edit]

Study Questions[edit]


Additional Resources[edit]

Reference[edit]

Journal Articles[edit]

Images[edit]

Related IPLab Cases[edit]

Shortness of breath is a common clinical manifestation of heart failure.

A focal network of small arteries and arterioles arranged in a radial pattern with a central red spot.

Hematemesis is the vomiting of blood.

Nodular hyperplasia of the prostate--characterized by large discrete prostatic nodules--is a common disorder in men over 50 years of age. The nodules cause the prostate to be enlarged and to have an increased weight. The human prostate is surrounded by a restrictive capsule. These nodules cause increased pressure within the capsule which leads to constriction of the urethra as it passes through the prostate. Urethral constriction leads to retention of urine.

Cirrhosis is a liver disease characterized by necrosis, fibrosis, loss of normal liver architecture, and hyperplastic nodules.