Question

Chief Complaint: 49-year-old man with abdominal pain, fever and yellowing of the skin and whites of the eyes.

History: Vincent Miller, a 49-year-old accountant, has had a "drinking problem" throughout most of his adult life. He has been hospitalized on several occasions over the years. He reports dull pain in the right, upper quadrant of the abdomen, intermittent fever of 3 weeks duration, and a yellowing of the skin and the whites of the eyes. A diagnosis of "alcohol-induced hepatitis (liver inflammation)" is listed in the chart. With excessive intake of alcohol, the liver switches over from the use of fats and carbohydrates as its primary "fuel" to the use of alcohol as its primary fuel. This can lead to excessive production of lactic acid, which, in turn, can cause inflammation of the liver tissue.

Answer the questions below.

1. Is the diagnosis consistent with the location of the abdominal pain? Explain your answer. How does this differ from circumstances of referred pain and what is the anatomical basis of visceral referred pain?

2. What is the physical relationship between the liver, gallbladder and duodenum? Be sure to include other organs that may share anatomical features.

3. If Vincent's liver disorder resulted in the production of a "gallstone," what danger might that present for his pancreas? Be specific.

4. Propose a possible treatment for the patient in this case study. How does this treatment improve conditions for the patient? Are these improvements seen at the cellular, tissue, organ or systemic level?

Answer 1

1. The diagnosis is consistent with the location of pain beacuse

RIGHT HYPOCHONDRIAC REGION consists of liver,duodenum,gallbladder and part of transverse colon.

Pain in this region may be mostly due to either liver pathology or gallstones, stomach ulcers and pancreatitis.

Vincent presented with a dull pain and dull pain is normally presented by visceral organs and he also presented with yellowish discoloration which indicates disturbance in liver metabolism.

Reffered pain differs from it because it radiates to another place which shares the similar dermatomes.

Visceral reffered pain occurs in somatic areas neurologically connected with the affected organs or when 2 organs share part of their central sensory projection are affected visceral referred pain occurs.when one of the organ is being treated the pain in another organ may also be relieved.

2.liver and gallbladder are related through biliary duct.

The common hepatic duct of liver is joined by cystic duct of gallbladder to form bile fuct .

This bile duct travels posteriorly through head of pancreas to merge with pancreatic duct and with superior aspect of duodenum forming hepatopancreatic ampulla.

Thus liver ,gall bladder ,panceas and 1st part of duodenum are merely related by ducts.

3. If Vincent's liver condition leads to gallstones then the gallstones may interfere with the flow of pancreatic enzymes to small intestine by obstructing the duct .

This leads to backflow of pancreatic enzymes to pancreas which causes inflammation in pancreas leading to pancreatitis.

4. Treatment for alcoholic hepatitis is as follows

Patient is advised to stop drinking and is deaddicted by giving pharmacotherapy in combination with some psycosocial interventions.DISULFIRAM is widely used.

GLUCOSTEROIDS act at cellular level by inhibiting PMNs and at nuclear level by inhibiting pro inflammatory transcription factors.

PTX-PENTOXYFYLLINE : this acts at molecular level by increasing cAMP and cGMP levels.it is used in case where glucosteroids cannot be given such as in renal failure .

ANTIOXIDANTS: alcohol is responsible for oxidative stress which is mainly responsible for liver damage.VITAMIN E is a powerful antioxidant.

in case of CHRONIC hepatitis C LIVER TRANSPLANTATION is the only effective treatment.