113 Cirrhosis of the liver Instruction Examine this patient’s abdomen. Salient features History • History of fatigue, weight loss, jaundice • History of alcohol abuse • History of hepatitis B, intravenous blood products • History of intravenous drug abuse • Mental status changes (hepatic encephalopathy) • History of drugs: methyldopa, amiodarone, methotrexate • History of Wilson’s disease, α1-antitrypsin deficiency • History of hepatitis C. Examination • Hands: • Clubbing, leukonychia • Dupuytren’s contracture (see Fig. 219.1), palmar erythema • Spider naevi, tattoos, hepatic flap, pallor • Scratch marks, generalized pigmentation. • Eyes and face: • Icterus, cyanosis, parotid enlargement. • Chest: • Spider naevi, loss of axillary hair, gynaecomastia. • Abdomen: • Splenomegaly (seldom >5 cm below the costal margin) • Ascites • Hepatomegaly (particularly in alcoholic liver disease). • Legs: • Loss of hair on the shins • Oedema. • Tell the examiner that you would like to look for testicular atrophy. Diagnosis This patient has spider naevi, gynaecomastia, splenomegaly and parotid enlargement (lesions) from cirrhosis caused by alcohol abuse (aetiology). The patient has hepatic flap, indicating liver cell failure (functional status). Questions What is cirrhosis? Cirrhosis is defined pathologically as a diffuse liver abnormality characterized by fibrosis and abnormal regenerating nodules. Mention a few causes of cirrhosis • Alcohol dependence • Hepatitis B virus infection (look for tattoos) • Lupoid hepatitis • Primary biliary cirrhosis • Haemochromatosis • Drugs: methyldopa, amiodarone, methotrexate • Metabolic: Wilson’s disease, α1-antitrypsin deficiency • Cryptogenic. How would you investigate this patient? • FBC including haemoglobin and platelet count • Liver function tests including γ-glutamyltransferase (GGT) • Prothrombin time • Hepatitis B markers • Serum autoantibodies • Serum iron and ferritin • Serum α-fetoprotein • Ascitic fluid analysis • Ultrasonography of the liver. Why does this patient have a low serum albumin concentration? Albumin is synthesized in the liver and in cirrhosis there is liver cell failure, causing impaired synthesis. Only gold members can continue reading. Log In or Register to continue Share this:Click to share on Twitter (Opens in new window)Click to share on Facebook (Opens in new window)Like this:Like Loading... Related Related posts: Permanent cardiac pacemaker/implantable cardioverter-defibrillator Cauda equina syndrome Abnormal gait Dystrophia myotonica Stay updated, free articles. Join our Telegram channel Join Tags: 250 Cases in Clinical Medicine Dec 4, 2016 | Posted by admin in GENERAL & FAMILY MEDICINE | Comments Off on Cirrhosis of the liver Full access? Get Clinical Tree
113 Cirrhosis of the liver Instruction Examine this patient’s abdomen. Salient features History • History of fatigue, weight loss, jaundice • History of alcohol abuse • History of hepatitis B, intravenous blood products • History of intravenous drug abuse • Mental status changes (hepatic encephalopathy) • History of drugs: methyldopa, amiodarone, methotrexate • History of Wilson’s disease, α1-antitrypsin deficiency • History of hepatitis C. Examination • Hands: • Clubbing, leukonychia • Dupuytren’s contracture (see Fig. 219.1), palmar erythema • Spider naevi, tattoos, hepatic flap, pallor • Scratch marks, generalized pigmentation. • Eyes and face: • Icterus, cyanosis, parotid enlargement. • Chest: • Spider naevi, loss of axillary hair, gynaecomastia. • Abdomen: • Splenomegaly (seldom >5 cm below the costal margin) • Ascites • Hepatomegaly (particularly in alcoholic liver disease). • Legs: • Loss of hair on the shins • Oedema. • Tell the examiner that you would like to look for testicular atrophy. Diagnosis This patient has spider naevi, gynaecomastia, splenomegaly and parotid enlargement (lesions) from cirrhosis caused by alcohol abuse (aetiology). The patient has hepatic flap, indicating liver cell failure (functional status). Questions What is cirrhosis? Cirrhosis is defined pathologically as a diffuse liver abnormality characterized by fibrosis and abnormal regenerating nodules. Mention a few causes of cirrhosis • Alcohol dependence • Hepatitis B virus infection (look for tattoos) • Lupoid hepatitis • Primary biliary cirrhosis • Haemochromatosis • Drugs: methyldopa, amiodarone, methotrexate • Metabolic: Wilson’s disease, α1-antitrypsin deficiency • Cryptogenic. How would you investigate this patient? • FBC including haemoglobin and platelet count • Liver function tests including γ-glutamyltransferase (GGT) • Prothrombin time • Hepatitis B markers • Serum autoantibodies • Serum iron and ferritin • Serum α-fetoprotein • Ascitic fluid analysis • Ultrasonography of the liver. Why does this patient have a low serum albumin concentration? Albumin is synthesized in the liver and in cirrhosis there is liver cell failure, causing impaired synthesis. Only gold members can continue reading. Log In or Register to continue Share this:Click to share on Twitter (Opens in new window)Click to share on Facebook (Opens in new window)Like this:Like Loading... Related Related posts: Permanent cardiac pacemaker/implantable cardioverter-defibrillator Cauda equina syndrome Abnormal gait Dystrophia myotonica Stay updated, free articles. Join our Telegram channel Join Tags: 250 Cases in Clinical Medicine Dec 4, 2016 | Posted by admin in GENERAL & FAMILY MEDICINE | Comments Off on Cirrhosis of the liver Full access? Get Clinical Tree
