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→Clinical Summary
== Clinical Summary ==
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.
== Images ==
Increased portal pressure also leads to increased pressure in the inferior hemorrhoidal veins and can lead to the formation of anorectal varices.</spoiler>
* <spoiler text="What is the pathogenesis of Wernicke's encephalopathy?">Wernicke's encephalopathy is caused by thiamine (Vitamin B1) deficiency. Chronic alcoholics often have poor diets and alcohol inhibits intestinal absorption of thiamine. Thus, some chronic alcoholics can develop Wernicke's encephalopathy which consists of foci of symmetric discoloration, softening, and punctate hemorrhages in the paraventricular regions of the thalamus and hypothalamus, in the mamillary bodies, around the aqueduct in the midbrain, in the floor of the fourth ventricle and in the anterior cerebellum. There is demyelinization and loss of neuropil. Even after treatment with thiamine, there is significant memory deficit.</spoiler>
== Additional Resources ==
=== Reference ===
* [http://emedicine.medscape.com/article/185856-overview eMedicine Medical Library: Cirrhosis]
* [http://emedicine.medscape.com/article/366426-overview eMedicine Medical Library: Cirrhosis Imaging]
* [http://www.merckmanuals.com/professional/hepatic_and_biliary_disorders/alcoholic_liver_disease/alcoholic_liver_disease.html Merck Manual: Alcoholic Liver Disease]
=== 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.
* 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 ===
* [{{SERVER}}/library/index.php?/tags/128-cirrhosis PEIR Digital Library: Cirrhosis Images]
* [http://library.med.utah.edu/WebPath/LIVEHTML/LIVERIDX.html WebPath: Hepatic Pathology]
== Related IPLab Cases ==
* [[IPLab:Lab 2:Fatty Change and Cirrhosis|Lab 2: Liver: Fatty Change and Cirrhosis]]
{{IPLab 12}}
[[Category: IPLab:Lab 12]]
