Liver Flashcards
A 56-year-old man with a remote history of intravenous drug use presents to an initial visit complaining of increased abdominal girth but denies jaundice. He drinks about 2 to 4 glasses of wine with dinner and recalls having had abnormal liver enzymes in the past. Physical examination reveals spider naevi, a palpable firm liver, mild splenomegaly, and shifting dullness consistent with the presence of ascites. Liver function is found to be deranged with elevated aminotransferases (aspartate aminotransferase [AST]: 90 U/L, alanine aminotransferase [ALT]: 87 U/L), and the patient is positive for anti-hepatitis C antibody.
Cirrhosis
A 63-year-old woman is admitted to the hospital with new-onset ascites. She has a history of long-standing diabetes and hypertension. Despite increasing abdominal distension, she has lost 13.5 kg in the last year. Physical examination reveals a lethargic-appearing woman with temporal wasting, massive ascites, and 2+ pitting oedema. She has numerous spider nevi over her chest wall and marked palmar erythema. She doesn’t smoke or drink alcohol.
Non-alcoholic fatty liver disease
A 38-year-old man presents to the emergency department for severe alcohol abuse with nausea and vomiting. He has a significant medical history of chronic heavy alcohol consumption of about one bottle of wine each day for about 5 years until 1 year ago; since then he has had severe intermittent binge alcohol intake. He reports no other significant medical problems. The patient is confused and slightly obtunded, and hepatomegaly is discovered on physical exam. His body mass index is 22. Pertinent positive laboratory values show low haemoglobin, AST elevation > ALT elevation, normal PT and INR, and very high serum alcohol level. Ultrasound of the abdomen shows fatty infiltration in the liver.
Alcoholic liver disease
A 50-year-old man presents to his general practitioner with complaints of fatigue for 2 months. He also notes distension of his abdomen and shortness of breath beginning 2 weeks ago. His wife reports that the patient has been having episodes of confusion lately. The patient has a significant medical history of chronic heavy alcohol consumption of about half a pint of vodka daily for around 20 years. On physical exam the patient is noted to have scleral icterus, tremors of both hands, and spider angiomata on the chest. There is abdominal distension with presence of shifting dullness, fluid waves, and splenomegaly. Laboratory examination shows low haemoglobin, low platelets, low sodium, aspartate aminotransferase (AST) elevation > alanine aminotransferase (ALT) elevation, and high prothrombin time (PT) and international normalised ratio (INR). Ultrasound of the abdomen shows liver hyperechogenicity, portal hypertension, splenomegaly, and ascites.
Alcoholic liver disease
A 12-year-old girl is ambulanced to A&E. A few days before she experienced central abdominal pain which moved to the right iliac fossa a few hours later. She felt much better this morning, before the pain became more severe than it initially was and spread to the whole abdomen.
Peritonitis due to a ruptured appendix
