Case Study: Liver Disease

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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
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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
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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 lt 50 µg/ dL Bilirubin 0.1-1.3
mg/dL Prothrombin Time Prolonged
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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
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CTs 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
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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.
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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