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Case Study: Liver Disease

Case Study: Liver Disease. CT, 52 yo car salesman presents at yearly Physical c/o: fatigue, numbness of hand/feet loss of balance, decreased memory Heartburn notes recent weight gain of 10#, decreased appetite. H& P reveals: Jaundiced appearance Spider angiomas on upper chest

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Case Study: Liver Disease

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  1. Case Study: Liver Disease CT, 52 yo car salesman presents at yearly Physical c/o: fatigue, numbness of hand/feet loss of balance, decreased memory Heartburn notes recent weight gain of 10#, decreased appetite

  2. H& P reveals: Jaundiced appearance Spider angiomas on upper chest (small dilated vessels characteristic of chronic liver disease) Proturberant abdomen Presence of an abdominal fluid wave and shifting dullness (indicative ascites (fluid accumulation in the peritoneal cavity) Enlarged liver with a firm edge Labs: Low RBCs, Hgb, Hct, Albumin, PT, AST, ALB

  3. Common Lab Tests to Monitor Liver Function Test NL Values [ ] in Liver Dz Albumin 3.5-5.0 g/dL Decreased ALanine Transaminase Aspartate Tranaminase Varies Alkaline Phosphatase by lab NL or Ammonia < 50 µg/ dL Bilirubin 0.1-1.3 mg/dL Prothrombin Time Prolonged

  4. Assumption: Liver Disease Which Type? Fatty Liver Hepatitis Alcohol Viral Origin (A through E) PEM Alcohol Infection Drug-induced Cancer Cirrhosis: fibrotic liver resulting from chronic inflammation. Alcohol abuse, infections, biliary tract obstructions Heart Disease, drug-induced

  5. CT’s Fatty Liver (Hepatic Steatosis) Causes: *Too much fatty acid synthesis *Too little fatty acid export *Oxidizes too little fatty acids *Inadequate release of fatty acids to the blood Accumulation of TGs Damage to hepatocytes Scar Tissue Develops Repeated rounds of inflammation and Repair Damaged liver tissue releases transaminases (ALT, AST) into The blood, along with bilirubin and alkaline phosphatase

  6. Diet Hx: 3 meals/day; reports 2 hard liquor cocktails before dinner, 2- 6 oz. Glasses of wine with dinner, and two hard liquor drinks after dinner. (42 drinks/week) Diet (as always) is Individualized: Energy: 35-45 kcal/kg/ CBW Protein: Cirrhosis: 1 to 1.5 g/kg Hepatic coma: Restrict as tolerated (~50 g) Sodium & Fluids: 1-2 gram Na; 1500-2000 ml fluid if ascitic. Restricting protein in cirrhotic pts may reduce risk of hepatic coma.

  7. Common Consequences of Cirrhosis Portal HTN Esophageal Varices: Hepatic Detour Portal HTN Ill-Effect #2: Ascites Develops Rising Blood Ammonia Levels Fetor Hepaticus (Musty, pungent breath) Rising Brain Ammonia Levels: Risk of Hepatic Coma Asterixis or Flapping Tremor

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