DiuES. A Case on the Liver Peggy Fender is well known to the emergency departmen
ID: 3479824 • Letter: D
Question
DiuES. A Case on the Liver Peggy Fender is well known to the emergency department (ED) saff She's a 59 year-old woman whose visit today is similar to her frequent visits in the past. She arrives in the afternoon, appearing intoxicated and complaining of abdominal pain, particularly in the right upper quadrant (RUQ) of her abdominopelvic cavity. "Another Fender bender," a nearby nurse whispers to Tim, the new physician assistant (PA) who is due to examine Mrs. Fender. Tim proceeds with his physical examination. Mrs. Fender appears emaciated with bruising of various ages on her arms, legs, and face. She is jaundiced (yellow-skinned) and has the strong smell of alcohol on her breath. Tim palpates the inferior border of her liver, which is hard and enlarged; Mrs. Fender moans with pain. Her entire abdomen is ascitic (swollen and fluid-filled). Mrs. Fender is not entirely coherent; she knows where she is and who she is, but is unable to relate anything about her present illness except a slurred, "My stomach hurts; quit poking it, you idiot!" Her coordination is poor when she much alcohol she's had to drink today even though she is obviously inebriated. Tim reviews her blood tests, which reveal elevated blood transaminases (liver enzymes), attempts to sit or stand. She becomes annoyed and indignant when Tim asks her how high blood glucose (hyperglycemia), and prolonged prothrombin time (PT - slowed clotting time). Based on her history and present findings, Tim diagnoses Mrs. Fender with alcoholic cirrhosis, which is the resuit of chronic inflammation of the liver from heavy, consistent alcobol ingestion. If aicohol abuse.continues long-term, it leads to fat accumulation in the liver, followed by fibrosis and severe liver dysfunction. 1. Besides the nurse'sde hased on many of his physical exam findings. Name at least "bender" comment, and Mrs. Fender's social history, Tim suspects three signs and/or symptoms that point to alcoholism, and briefly explain why cach sign/symptom may wn for its ability to remove certain toxins from the blood. It can 2. The liverhus function because its cells, or hepatocytes, contain large quantities of perfortn n and peroxisomes, and also have an extensive smooth endoplasmic Brieftly describe how these three organelles contribute to this of the liver 3. Mrs. Fender's jaundice is caused by the accumulation of bilirubin in her blood and tissues. What is the normal fate of bilirubin, and what role does the liver play? Explain how Mrs. Fender's cirthosis is related to her jaundice. m that ca This is the buccal cavity in a human and is (chewing) takes placeExplanation / Answer
1. The signs and symptoms which point to alcoholism are as follows-
i) On palapating the inferior border of the liver it is found to be hard and enlarged and the patient moans in pain. Alcohol abuse causes inflammation of the liver.
ii) The whole abdomen has been found to be ascitic or filled with fluid. It is a case of liver hepatitis due to alcohol intake.
iii) Poor coordination when sitting or standing. Alcohol causes movement disorders.