Alcoholic Liver Disease - Case Study Example

I. Case Study 1 Answer to Questions: 1. My provisional diagnosis based on the above presentation is alcoholic liver disease. 2. The signs and symptoms considered are fatigue, loss of appetite, pale skin, presence of spider nevi in the chest, lost and tunes out easily, and history of moderate to heavy alcohol drinking. 3. Based on the condition presented, VC may have developed hepatitis in the liver (fatty liver) as fatigue, pale skin, loss of appetite but gaining weight are common symptoms of liver disorder. Moreover, there may be pain or tenderness on the liver, fever, muscle and joint pains, nausea, and others (Palmer, 2004 p.16). 4. Hepatitis or liver inflammation is often caused by viruses but it can occur due to excessive alcohol intake, exposure to certain drugs or toxic chemicals, and fatty liver disease (Rady et al, 2008, p.789). 5. The liver is the most active organ in the body as it receives and process nutrients absorbed by the small intestine. It also produces bile that emulsifies fat during digestion and detoxifies drugs and alcohol (DeBruyne et al, 2007, p.552). Damage in the liver therefore can upset these functions and result to severe health and nutritional problems. For instance, The liver’s triglycerides are packaged into very-low-density lipoproteins and exported to the blood stream thus fat in a damaged liver can accumulate due to imbalances between the amount of fat synthesized from and exported from the blood. A fatty liver then resulted to abnormal levels of liver enzymes in the blood responsible for elevated blood concentrations, increased levels of cholesterol, and glucose (ibid, 552). 6. A fatty liver can result to liver cell necrosis particularly when alcohol or drugs are involved. Since there are imbalances in oxidation, esterification, excretion of fatty acids, fatty liver can lead to enlargement of the liver, cholestasis, portal hypertension, and, ascites. Moreover, liver cell necrosis in a fatty liver can lead to progressive fibrotic process responsible for in the development of cirrhosis (Chernoff, 2008, p.258). According to Kuntz & Kuntz (2008), complete reversibility can be achieved of the causes of fatty liver are eliminated. However, existing fibrotic process often remains thus its danger should not be underestimated. Prognosis therefore depends on whether the causes of fatty liver and associated risk factors can be eliminated. For instance, some 10 to 15 percent of patients die within 10 years as a result of complications associated with cirrhosis (p.602). 7. Causes of constipation include (Salamon, 2005, p.350): a. Dehydration b. Consumption of a low-bulk diet c. Sedentary lifestyle d. Lack of regular exercise e. Frequent repression of the urge to defecate 8. Loose and frothy stools that stick to the bowl are signs of increased fat in the stools which is called steattorrhea, the third most common cause of chronic diarrhea (Paulman et al, 2006, p.209). Causes of steatorrhea include (ibid, 209): a. Fat mal-absorption caused by an intraluminal disgestive disorder, mucosal blockage of absorption at the enterocyte level, or a postmucosal blockage. b. Acute or chronic liver diseases due to mal-digestion of fats c. Short bowel syndrome d. Ingestion of certain foods such as large amount of peanuts or use of liquid paraffin to treat constipation e. Laxative abuse that can hasten gastrointestinal transit and preclude sufficient absorption of fats. 9. Since fatty liver is the accumulation of fat in liver cells, the condition may be confirmed by taking a sample of liver tissue or liver biopsy. Images of the liver may be obtained by an ultrasound test where a bright image in a ripple pattern indicates a fatty liver. Computed tomography scan (CT scan) can also attest to the presence of fatty liver, a liver that is less dense than normal (Rees, 1997, p.277). 10. Some common causes of prolonged anorexia include acute pathologic causes such appendicitis, heart or renal failure, pharmacologic causes such as substance abuse including alcohol, tobacco, drugs, and other stimulants that can affect appetite. It can also be the result of a primary eating disorder such as anorexia nervosa, depression, personality disorders, schizophrenia, and bipolar disorders. Social factors such as bereavement, stress, and loneliness can also lead to prolonged anorexia (Paulman et al, 2006, p.9). II. Case Study 2 Answer to Questions: 1. This type of cough is productive as it produces white phlegm. As opposed to non-productive type which is dry and irritating, the cough is likely caused by bacterial infection as evidence by significant amount of white sputum (Edwards et al, 2006, p.27). 2. Common causes of productive cough include (Leppert, 2003, p.403): a. Chronic bronchitis from cigarette smoking b. Acute respiratory infection among non-smokers c. Bronchiectasis particularly when large quantities of purulent sputum is present d. Chronic respiratory infections such as tubercolosis. e. Environmental pollutants, asthma, and pneumonia 3. Primarily, this condition suggest chronic bronchitis as the cough last longer but since the phlegm is sometimes streaked with blood, the possibility of bronchietasis and lung cancer cannot be ruled out particularly when breathlessness and chest pain are present (Appling, 2003, p. 205). 4. My diagnosis is based on the following symptoms, signs, and others: a. Productive cough – the presence of white stringy phlegm b. Streaked of blood in the phlegm and wheezing c. Recurring cough that is worst on winter d. BR is a heavy smoker e. Coughing getting worse on old and mouldy bedroom f. Breathlessness and tight chest on exertion g. Skin lesions that are indicative of bacterial infections (Root et al, 1998, p.489). 5. Chronic cough and phlegm are common symptoms of chronic bronchitis and in advance cases phlegm expectoration and dyspnoea (shortness of breath which is a clinical feature of emphysema) often coexist. Dysponea is indicative of chronic airflow limitation resulting to wheezes on lower lobes of the lungs (Stellman, 1998, p.10). 6. Chronic bronchitis can lead to severe dyspenea, respiratory failure, pneumonia, enlargement of the right heart ventricle, lung collapse, high concentration of red blood cells or polycythemia, and emphysema,(Davis et al, 2012, p.1). 7. BR’s skin condition will be likely diagnosed as psoriasis, a hereditary chronic skin disease marked by epidermal proliferation (Anderson et al, 2009, p.662). 8. Five different supporting diagnosis include (Dockery, 1999, p.73): a. The common location of psoriasis is the elbow, knees, back, scalp, and other extensor surfaces b. Red background covered with uniform layer of silvery scale c. Psoriasis is not necessarily itchy d. It gets worse when BR drinks alcohol e. Hereditary – BR mother also suffered from the same condition 9. Clinical patterns of this condition include (Dockery, 1999, p.73): a. Raised skin lesions, deep pink with red borders and silvery surface scales b. May be cracked and painful c. Blisters oozing with pus that occurs on the palms and soles d. Pitted, discoloured and thickened fingernails e. Itchy skin in some people f. Joint pain particularly in people affected by psoriatic arthritis 10. True – psoriatic arthritis III. Case Study 3 Answer to questions: 1. The most probable diagnosis of this condition is cardiorespiratory disease. 2. Symptoms and signs considered include breathlessness when climbing up the stairs, gasping for air when sleeping, snoring, breathlessness on lying flat, number of pillows, cough and sputum. In addition, history of hypertension and parents health (Flynn, 2007, p.42). 3. Investigations may include: a. Inquiring about the onset of breathlessness whether it is acute or gradual. b. Inquiring about the circumstances of the breathlessness – on exertion or at rest c. When it is worse – night or day? d. Does it only occur when lying flat? e. Investigate associated symptoms including severity of breathlessness 4. People who develop pink, frothy sputum are likely suffering from pulmonary edema which is a manifestation of vascular injury and extravasation of red cells. Bloody sputum is sometimes indicative of mitral stenosis when a dilated pulmonary-bronchial venous connection is ruptured (Goroll & Mulley, 2009, p.357). Acute cardiogenic pulmonary edema is often caused by exacerbation of congestive heart failure particularly when there is capillary pressure due to increase in left ventricular end-diastolic pressure and volume (Marinella, 2003, p.11). 5. False as pink frothy sputum is associated with congestive heart failure caused that may be caused by different factors including hypertension (ibid, 11). 6. Factors that may have contributed to KC’s high blood pressure include lack of regular exercise, stress from long hours of work, fatty foods, beer drinking, hereditary, and presence of pulmonary edema. 7. KC’s urinary symptoms include: a. Frequent urination b. Difficulty producing stream of urine c. Thin and dropping urine stream at the last part 8. Differential diagnostic include (Kelvin & Tyson, 2010, p.6): a. Frequent urination caused by long-term bladder or urinary tract infection b. Inflammation of the prostate gland that can also case frequent and difficult urination. c. Nocturia particularly when frequent urination occurs at night 9. Some investigations that may be conducted include (Garber, 1998, p.16): a. Biopsy in order to examine a piece of living tissue b. CT scan in order to see the precise image and relationship of body structures c. Cystogram or Intravenous Pyelogram to test the urinary bladder, kidney, and ureters. d. Ultrasound 10. Causes of increased frequency of micturition include without an increase in urine volume (Resnick & Older, 1997, p.5): a. Reduced bladder capacity due to inflammation, infravesical obstruction, dysfunction, and others. b. Urinary tract infection IV. Case Study 4 Answer to Questions: 1. Numbness of the middle may caused by temporary loss of blood supply. 2. TM’s symptoms is more likely an indication of systemic lupus erythematosus or SLE with Raynauds phenomenon – joint pain in hands and skin rash respectively (Galvin & Bishop, 2011, p.436). 3. There is a rash on her face couple with joints pain in her hand and history of tonsillectomy. 4. The doctor may request the following blood test (ibid, 436): a. ANA Blood Test to determine the type of lupus b. Slide agglutation test using latex coated deoxynucleoprotein 5. Body systems that may be affected include (ibid, 436): a. Cardiovascular b. Renal c. Musculoskeletal 6. Symptoms include (Rosenthal, 2002, p.13): a. Cardiovascular changes – slow pulse, low or high blood pressure b. Cold intolerance – sensitivity to cold c. Depression d. Weight Gain and slow metabolism 7. Endocrine disorders include (ibid, 14): a. Addison’s disease b. Hashimoto’s tyhroditis c. Thyrotoxic Grave’s disease d. Autoimmune hypothyroidism 8. a) Thalassemia is a group of hereditary anaemia in which synthesis of one or both chains of the haemoglobin molecule is defective. b) It has two type – alpha-thalassemia and beta-thalassemia (Ricci & Kyle, p.609). 9. Iron deficiency anaemia (ibid, 607) 10. Systemic lupus erythematosus or SLE and Raynaud’s phenomenon are a multisystem connective tissue disease because it is characterized by widespread inflammation and associated with auto-antibodies. 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