Alcoholic Hepatitis - Coursework Example

?[The [The [The Case study: Alcoholic Hepatitis Sadia is a 20 year old female She works in a bar and lives in a residential house with her friends. Her work environment has an influence on her social life and drinking habit. This is made worse by the fact that she over indulges in alcoholism to the extent that she gets too drunk to remember details of her nights out. Her sex life is also worrying and being single, Sadia is likely to have a horde of sexual partners. She risks exposing herself to sexually transmitted infections. On visiting her medical doctor, she reports the following signs; Weight loss, lowered appetite and altered bowel habit, fatigue and feelings of nausea and slight skin discoloration. She is later diagnosed with Chlamydia and alcoholic hepatitis Alcoholic hepatitis is described by O'Beirne et al. as an inflammation of the liver that result from over indulgence in alcohol drinking after a significantly long period of time. Over indulgence in alcohol has an impact on liver functioning test. This is as a result of steotosis. In this case, hepotocytes show droplets of triglycerides. Sadia is reported to have slight skin decolouration. This is a clinical symptom of jaundice, which is associated with liver failure. Jaundice occurs after long period of alcohol abuse. This means that she has hepatic failure that resulted from increased level of balirubin in extracellular fluid (O'Beirne, 504-507). In England and Wales, Sargen reported that 5,000 people die yearly from chronic liver diseases. The leading cause of liver injury continues to be excessive consumption of alcohol that manifest as alcoholic hepatitis. 65% of those affected by alcoholic hepatitis often die from it. Patients with alcoholic hepatitis have one month mortality rate ranging from 0-50%. Hepatic encephalopathy, hyperbelirudinemia, derangement in renal failure and prolonged prothromine time are the clinical symptoms of developed alcoholic hepatitis (Sargen, 24-56). These imply that Sadia too falls in this bracket since she had signs of hyperbelirudemia. She reported altered bowel habit; therefore, she is a suspected case of derangement in renal failure. She is developing chronic alcoholic hepatitis. Inflammation of the liver is caused by harmful drugs, poisonous bacteria and even protozoa. For the case of Sadia, excess alcohol which is poisonous triggered destruction of the alimentary canal including the mouth, stomach, intestines and the liver. Sadia reported that she drinks around 25 units of alcohol weekly this is above recommended threshold, therefore, it over works her liver. Alcoholic hepatitis majorly targets the liver. She is clearly malnourished because of her uncoordinated eating habit, studies and work. Being a syndrome that relies on severity, manifesting symptoms vary. Sadia is likely to display the following: Anorexia, Sadia is likely to develop fear of eating. Swelling of the abdomen due to fluid accumulation Mental confusion Weight loss Abdominal pain Hepatic failure Fatigue and loss of appetite Sadia should be treated by a gastroenterologist – a specialist in digestive disorder. It’s obvious that Sadia has liver condition but it’s advisable that she should undergo liver biopsy to confirm if she has alcoholic hepatitis with cirrhosis. To treat her worsening renal impairment, O'Beirne recommends that a dose of terlipressin 1 mg, six hourly, would be started. Encephalopathy would be treated with lactulose and phosphate enemas. This management is meant to resolve encephalopathy. (O'Beirne, 504-507) Sadia will then visit the outpatient department for counseling and support. With total abstinence, improvement in liver function would be expected within a period of one year. Patients with alcoholic hepatitis have malnutrition. Until the time of check up, Sadia had high intake of calories resulting from her eating habit and alcohol consumption. Besides drinking, she said that her diet majorly consisted of white pasta and toast. She should be recommended to a dietitian because degree of malnutrition correlates with mortality rate in patients with alcoholic hepatitis. Further, nutritional support is related with improvement in liver test. Protein is said to provide positive nitrogen balance. Studies by Mendenhall have shown that protein energy malnutrition is present in all patients with clinical diagnosis of alcoholic hepatitis and that this is an independent risk factor for early mortality. Mendenhall argued that low protein diets in patients with alcoholic hepatitis worsens encephalopathy, and that in patients who can take standard antiencephalopathy medication, a high protein diet is well tolerated and improves encephalopathy (Mendenhall CI, 258–265). It is invariable that Sadia’s history of alcohol abuse and withdrawal symptoms be examined. Since she has been drinking until the time of admission, Sadia should be treated for withdrawal. Abstinence from alcohol is the foundation of therapy for alcoholic hepatitis. Sadia must be assisted to do this. After counseling, she should be referred to chemical dependency team to begin rehabilitation. If her case is severe, she may need intravenous chlormethiazole; this can be administered in high dependency intensive unit. I would advise Sadia on the essence of abstinence from alcohol abuse since it’s the most important intervention. She should be made to understand that in case her liver function is irresponsive to treatment, she could get a liver transplant after three months of abstinence. Sadia should be offered intensive management, counseling and support during her rehabilitation. British liver trust is the national charity for adults with liver diseases. Started in 1988, the trust seeks to make known the problem of liver disease in the UK. Its aims include raising awareness of all aspects of liver disease through the media, policy groups and representatives of the medical profession and patients. On a political front, the trust lobby for change in alcohol policy by regularly submitting proposals to the government. Working with Alcohol Health Alliance (ALA), the trust has a mission of reducing damage caused to health by alcohol misuse (Sargen, 24-56). Case study: Chlamydia Chlamydia is a sexually transmitted disease caused by the Chlamydia trachomatis; an intercellular bacterial pathogen. The bacterial pathogen occurs in two forms; reproductive and infective form. The infective form invades a body cell and then differentiate into a reproductive form while the reproductive form is non infective and resides inside a body and produces new infective cells. Adams et al reports that Chlamydia infection is the most common form of sexual transmitted disease in the UK with more than 160,000 cases reported 2010 having grown from 60,000 cases in 2000, its termed as highest growing infection in the UK. More than 85% of infected women and 40% of infected men are without symptoms. If not treated 20-40% of women with Chlamydia infection develop pelvic inflammatory disease. It also accounts for 15% cases of women infertility and is primary cause of ectopic pregnancy (Adams, et al. 354-362) Some strains of Chlamydia cause eye, respiratory and genital infections. Because it is transmitted through sexual activity, individuals with many sexual partners are at risk of Chlamydia infection. Sadia is likely to be a victim whose signs and symptom cannot manifest. She is likely to have engaged herself in irresponsible sexual behaviour because of her drinking habit. Her sexual patners too are at risk and should be advised to seek medical attention. Sadia would display the following signs and symptoms: If left untreated, she would develop vaginal discharge that results from inflamed cervix, Frequent urination or pain while passing urine. Pain during sexual intercourse. For men; may have swollen testicles, burning sensation while passing urine and inflamed testicle. A sample of cervical secretion is taken to the lab for endocervical culture testing. This can also be tested with urine test. Short course of antibiotic tablets would be administered for treatment. Sadia sexual history is important in treatment and management of Chlamydia. She might be asked for partners she had had sexual intercourse with for a period of six month for testing and treatment. To avoid re-infection and further spread, Sadia should not have penetrative sex until she has tested negative for Chlamydia. If she remained untreated and undiagnosed, she could develop salpingitis; pelvic inflammatory disease in which the fallopian tube and the uterus are infected. She would have Crevicitis; which is inflammation of the cervix. As a result, she is likely to report a yellowish virginal discharge and experience pain during sexual intercourse. These two conditions are the root cause of infertility in women (Adams et al. 354-362). National Chlamydia Screening Program (NCSP) was established in 2003 in England, (NCSP) aimed at controlling Chlamydia through early detection and treatment. Adams et al. mentioned its main objective as that of preventing development of sequel thereby reducing transmission. Since many infections are asymptomatic, a large proportion of cases remain undiagnosed, although infection can be diagnosed easily and effectively treated (NCSP, website). Sadia should review her lifestyle, stop alcoholism and change for the better. If she must work in a bar, then she should be responsible enough and avoid lifestyles that compromise her health. Chlamydia and alcoholic hepatitis are lifestyle diseases that continue to hunt us. Work cited Adams Elisabeth, Charlett, and Edmunds Hughes “Chlamydia Trachomatis in The United Kingdom: A systematic Review and Analysis of Prevalence Studies.” Journal for Health Professionals and Researchers in All Areas of Sexual Health 80.5 (2004): Print. Great Britain. Parliament. House of Commons. Committee of Public Accounts. Young people's sexual health: the National Chlamydia Screening Programme. 7th report. 2009-10 sessions. London: The Stationery Office, 2010. Website. Mendenhall CI, Moritz TE, Roselle GA, et al “Protein Energy Malnutrition in Severe Alcoholic Hepatitis: Diagnosis and Response to Treatment.” Journal of Parenteral and Enteral Nutrition 19:258–265. (1995). Print O'Beirne, James, David Patch, Steve Holt, Mark Hamilton, Andrew K Burroughs. Alcoholic Hepatitis—The Case For Intensive Management Post Graduate Medical Journal 76. 898 (2000): 504-507. Print Sargen, Suzanne. Liver Diseases: An Essential Guide for Nurses and Health Care Professionals. London: John Wiley & Sons, (2009). Print. Understanding Human Anatomy and Physiology in relation to practice Abstract. It is important to understand and apply knowledge of anatomy and physiology by incorporating theory and practice. Keen understanding of human anatomy and physiology consolidates and develop skills of the medical practitioner and understanding in relation to the function of organs and the needed assessment of key systems. In addition, the rationale for the delivered care and the impact anatomy and physiology has on provided care and treatment is emphasized. Structure and its defining terminologies are of essence to both doctors and patients. Introduction Box et al. said that the study of anatomy alone without reference to both normal and abnormal functioning of the body has little meaning. This knowledge is an essential component of medical practice. Understanding Structure and function of the human body will help one detect its abnormal function (Box et al, website). This paper will draw illustrations from digestive system to demonstrate how knowledge of normal anatomy and physiology impact on Human Anatomy and Physiology in relation to practice. Understanding normal anatomy and physiology of the human body will enable a physician to identify and interpret causes of digestive disorders, effects on the body and resulting symptoms (Wingate, 94). Familiarity with individual digestive track system and demonstration of basic clinical treatment techniques prove vital when supporting patients. For instance, knowledge of bowel function which is always affected by drugs, diseases, and social pattern will be important in determining the cause. A patient may indicate alteration in frequency, consistency, presences of blood and mucus is far from the normal bowel function. These could be an indication of digestive disorder and there might be need for surgery. These symptoms, if exploited would enable the medics to know the extent of damage and course of action to take. Wingate also said that knowledge of anatomy will prove vital in pointing out how organs are affected, and therefore, give the right diagnosis to individuals who display these symptoms. This knowledge will also be instrumental in determining the type of treatment. Bowel behaviour may account for several infections, inflammation, ulcers, perforation of the digestion track, blocked blood flow and uncoordinated muscles blocked by obstruction (Wingate, 94). This is in contrast with normal anatomy of the digestive track. Abnormal liver may be inflamed, enlarged, or softened while normal liver should be brown with a smooth surface. In such a case, knowledge of the normal liver may be used to assess extend of liver damage. This knowledge also extends toward appreciation of normal pancreas and liver functioning because inflammation of these organs affect there function and structure. According to Barrett, Illustration of the internal structure of the digestive system in the normal body function using photographs of live models, specimen form animal is a great provision to understand surrounding structures, and surface landmark. This knowledge is clear as we focus on which part of the digestive system is worked on, where it is attached and more important how to approach the affected organ (Barrett, 8-20). An individual who reports abdominal pain could be provided with medical attention. Abdominal pain is a vital pointer in identifying the cause. Patients with pain that comes and goes in waves are likely to have organ blockage, which could be kidney stones, gallstones or even intestinal obstruction. When a patient rolls on bed as a result of pain, it might be an indication of pancreatitis. Physicians will perform tests to help ascertain several suggested signs and symptoms and physical examination result. Computed tomography can help identify the cause of the pain. The doctor will now examine the affected organ and carry out tests while contrasting with normal function. In case a patient has inflamed liver, a liver biopsy could be done to rule out other liver complications such as fatty acids and cirrhosis in order to investigate alcoholic hepatitis. Location of body organs and tissues is a key component of anatomy and physiology. In case a patient reports pain, the doctor ought to examine the nature of pain; its area of origin, its frequency and intensity to determine the affected digestive organ as Barrett said in his study. For example, pain in the upper left abdomen may be; inflammation of the gallbladder, enlargement of the liver, hepatitis, and abscess in the liver and perforated duodenal ulcer may be suspected. Patients with pain in lower right abdomen could be having appendicitis or diverticulitis. Pain in the upper, left, abdomen could indicate gastritis or ruptured spleen. Understanding surrounding structures and surface landmark of normal body structure would be useful physical examination of a patient who presents a disorder (Barrett, 8-20). Earl, et al. discussed that terminologies and illustration in oral description of surgery as an element of anatomy and physiology is important to medical practitioners. Knowledge of human body structure, and use of accurate terminology when administering surgical procedure or referring a patient for specialized treatment, is vital. They gave examples of such terminologies that may be used interchangeably, while others are obsolete. We may also have multiple terminologies for the same structure for instance rectus facia is also called internal oblique aponeurosis and the conjoined tendon (Earl, et al., 41-56). It’s proposed that basic anatomy and physiology should be thought at all school levels to build on public awareness. Before carrying out an operation, it’s important to explain the surgical procedure to the patient and to show them where you’ll have an incision. It is disturbing to learn that most patients do not know there body organs. This has compromised the role played by patients during surgical operations. Some agree to terms but later on will dispute and even take legal action against the physicians in question. Surgeons issuing instructions to assistants should use standard terminologies to describe body cavities and region as well as cell structure and function. Barrett asserted that one can be guided by photographs of live models showing normal anatomy and physiology (8-20). Anil, pointed that patients with conditions like crohns disease, colorectal cancer and diverticulitis will require laparoscopic surgery. Knowledge of physiology and anatomy will have a hand in making incision. In this surgery, two or three incisions of 5-10mm are made in the abdomen to allow access to the ports to be installed. The physician will then use laparoscope from which a picture of the abdomen would be transmitted on a video monitor. This type of operation could be used in total abdominal colectomy that involves surgical removal of the large intestine to treat ulcerative colitis, crohns disease or even acute constipation (Anil, website). It is clear that during this procedure, you need to know how normal abdomen looks like in order to make an observation. Physicians are argued to embrace emerging technology and apply new treatment methods. Understanding anatomy and physiology of the body enables one to make a correct incision and know the exact area for incision. Box stated that location of the organ in question in relation to other adjacent organs will be of help. Some factors such as; obesity, inability to visualize organs, bleeding during operation or dense scar tissue caused by prior abdominal operation may influence the surgeon to choose either laparoscopic surgery or an open surgical procedure. This may influence the type and size of incision made (Box et al, website). Open surgical procedure may require a large incision to access the area of interest. Sound surgical decision is made as to which procedure to adopt. Complications may arise in any normal surgical procedure and these may include; bleeding and infections. Knowledge of human anatomy and physiology is needed to combat risk of injury to the adjacent organs, blood vessels, nerves and urinary bladder. Surgical site infection is a case in which either the skin or organs are infected during surgical procedure Further treatment, remedial product and lifestyle changes are important facets of aftercare services for patients who had been admitted on account of digestive disorder. In most cases, a recommendation is made for complementary therapist. Wingate said that after treatment, most patients have succumb to digestive disorder because either they were not referred for complementary therapy or did not understand instructions given by medical practitioner accurately (website). Nutritionists and other complementary therapist must understand anatomy and physiology in order to give aftercare services. For instance, in case of diverticulitis one would be advised to introduce diet with high fibre content only after acute infection has improved. Patients with liver and pancreas related disorders are advised against alcohol use. Knowledge of normal cell structure, function and more importantly chemical composition would enable determination of indication and contraindication. Physician should be able to detect any signs of hypersensitivity of any antigen in body function. An immediate severe reaction is common when treating pancreatitis and during organ transplant. Such knowledge is useful in administering treatment and medication. Treatment of pancreatitis using amylase is contraindicated in pregnant women as it affects the unborn baby. High fibre diet is contraindicated in surgical procedure that involved removal of the affected colon or intestine until the patient has healed. Follow up and constant medical check-up on functioning of the digestive organs is important as new complications may be identified. Critics of anatomy and physiology are of the opinion that physiology should be separated from anatomy. They advocate for specialized type of treatment. To them physicians should deal with functioning of the human body. The human body is enormous and complex; a person cannot understand it in holistic manner. They argue that though interrelated; body systems can be divided into different entities. This thought is misguided since physiology won’t exist in a vacuum. It is clear that function come from structure and you can’t treat one and ignore the other. In conclusion, anatomy and physiology of a normal human being is so important in medical practice. Understanding of the human structure and function is the fountain of treatment since alteration of this result to defect in anatomy and physiology of the body. We use knowledge of anatomy to identify causes of diseases and rectify anomalies. As discussed in the paper, this knowledge governs surgical operations and supplementary therapy. Patients too need this information in order to understand the structure and functioning of there bodies. Work cited Anil, Minocha, and Adamec Christine. The Encyclopedia of the Digestive System and Digestive Disorders. New York: Facts on File (2004). Website Barrett, Kim E. Gastrointestinal Physiology (LANGE Physiology Series) New York City. McGraw-Hill Medical, (2005). Print. Box, Charles, W. McAdam Eccles Clinical Applied Anatomy: or the Anatomy of Medicine and Surgery California: P. Blackstone’s, (1906). Print Earl, Krieg, M.D and Dertoid Mitch. “Anatomy and Physiology of the Inguinal Region in The Presence of Hernia.” Core Clinic Journal. 137.1 (1953). Print. Windate, Thomas Todd. The Clinical Anatomy of the Gastro-Intestinal Tract. Manchester: University Press: (2010). Print. Read More