Question

Mr. V is a 55-year-old alcoholic who checked into a clinic, complaining that he has been experiencing a persistent cough and feeling more fatigued, nauseous, and irritable. In addition, he is experiencing more frequent memory lapses. His stomach is distended, but on palpation, his liver is small in size and firm, indicating cirrhosis. Lab tests indicate a decrease in hemoglobin, albumin, levels with elevated serum bilirubin and ammonia levels.

a) Provide a specific rationale for each of Mr. V’s manifestations and blood values.

b) what is the prognosis?

Answer 1

Answer a

This patient is suffering from liver cirrhosis due to alcoholism

The clinical history of this patient suggests that he is undergoing decompensation

• Abdominal distension ( secondary to ascites)
• Breathlessness ( due to the ascites compressing upon the diaphragm)
• Irritability

The Cause for anemia in this patient is

1. Poor nutrition
2. Iron deficiency
3. Folic acid deficiency
4. Hypersplenism ( destruction of RBC)
5. Bleeding from esophageal varices
6. Rarely due to hemolytic anemia ( Zieve's syndrome = acute hemolysis + alcoholic fatty liver + extreme hyperlipidemia

Cause for low albumin

1. Reduce the synthesis of albumin by the liver
2. Sodium and water retention causes an increase in intravascular volume.

Cause for High Bilirubin

1. Impaired hepatic bilirubin clearance
2. Impaired bilirubin conjugation due to reduced of glucuronly conjugation
3. Increase hemolysis due to splenomegaly ( increases the level of bilirubin)

Cause of High ammonia level

1. Normally liver converts ammonia into glutamate and urea
2. Due to liver cell failure, this conversion doesn't happen
3. Increase muscle break down

Answer b)

The prognosis in Liver cirrhosis can be assessed by calculating the Child-Pugh score. This scoring system utilities following parameters

1. Ascities
2. Encephalopathy
3. Bilirubin
4. Albumin
5. prothrombin time

Each parameter is giving points and the total score is calculated. Based on the total score the patient is classified into a class

	class A	Class B	Class C
total points	5 - 6	7 - 9	10 -- 5
1 year Survival	100%	80 %	45%

This patient has the following points Ascites, irritability ( suggests the presence of encephalopathy), low albumin, and high bilirubin. All these parameters suggest that the patient is in Class C. Therefore the prognosis is poor.