IPLab:Lab 2:Fatty Change and Cirrhosis

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Clinical Summary[edit]

This 54-year-old man with a long history of alcohol abuse had been admitted to the hospital numerous times for abdominal pain thought to be due to gastritis or a peptic ulcer. On several occasions his serum amylase level was elevated into the range of 300-500 u/L indicating relapsing or recurrent pancreatitis. Three weeks prior to his demise, the patient began an alcoholic binge. The binge continued until three days prior to the patient's death at which time he developed fever and malaise, prompting him to cease drinking. He was brought to the hospital semi-comatose and with a fever of 105.4°F. Shortly after arriving at the hospital, the patient died from massive pneumonia.

Autopsy Findings[edit]

At autopsy, a necrotizing lobar pneumonia was present which contained organisms consistent with Klebsiella pneumoniae. The liver was enlarged--weighing 2700 grams--and had a yellow-orange color. The liver was firm to palpation and the cut surface had a slightly granular appearance suggestive of early cirrhosis. The pancreas showed multiple areas of fibrosis.

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Related IPLab Cases[edit]

A normal PaCO2 is 35 to 45 mmHg.

Gastritis is inflammation of the stomach.

A normal serum amylase level is 30 to 110 u/L.

Chronic inflammation of the pancreas (pancreatitis) is most often caused by alcoholism or biliary tract calculi.

In alcoholics, aspiration pneumonia is common--bacteria enter the lung via aspiration of gastric contents.

Necrotizing lobar pneumonia is a severe acute pneumonia caused by virulent organisms and aspirated of gastric contents.

A normal liver weighs 1650 grams (range: 1500 to 1800 grams).

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

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.