Hepatic Encephalopathy

Cirrhosis has many causes, although the most common ones are alcoholism and chronic viral hepatitis B, and C. Cirrhosis can develop as a

Physical Examination: General: The patient is an alert, oriented male appearing his stated age. He appears to be in moderate distress. Vital signs: blood pressure 132/78 and pulse 68 and regular. Temperature is 38.56 oC (101.4 oF). HEENT:Normocephalic, atraumatic. Pupils were equal, round, and reactive to light. Ears are clear. Throat is normal. Neck: The neck is supple with no carotid bruits. Lungs: The lungs are clear to auscultation and percussion. Heart: Regular rate and rhythm. Abdomen:Bowel sounds are normal. There is rebound tenderness with maximal discomfort on palpation in the right lower quadrant. Extremities: No clubbing, cyanosis, or edema.

1. What are the common manifestations of alcoholic cirrhosis? Which of these are secondary to

Chweyah, dated 08/11/2017, indicated that the claimant presented for a follow-up visit after his discharge from the hospital on 08/08/2017. He was admitted on 08/04/2017 due to normocytic anemia, pain in both knees, starvation ketoacidosis, hypertension, gout with tophus, and duodenitis. The esophagogastroduodenoscopy revealed erythematous duodenopathy, erythematous mucosa in the antrum, and small hiatal hernia. He had a colonoscopy which revealed internal hemorrhoids. Objective findings showed blood pressure of 112/86 with a pulse of 105. He was diagnosed with quadriceps weakness, pain in both knees, normocytic anemia, type 2 diabetes mellitus, hypertension, stable chronic kidney disease stage III, and bilateral impacted cerumen. It was noted that he can return to work on 08/16/2017 with limitations of not standing for more than 10 minutes at a time for 1

Gil’s assessment, we can look back to see the relatable factors. First, Hispanics usually carry high rates of abstinence from alcohol than other ethnicities, but those that do consume alcohol, often have higher rates of binge drinking (NIH, 2017). Not only does higher rates of binge drinking occur, but Hispanics also have a higher risk for developing alcohol-related liver disease, more so than whites (NIH, 2017). His health history shows that he, at times, consumes alcohol excessively, which is one of the main causes of cirrhosis (Nordqvist, 2015). Excessive consumption of alcohol for men is considered as drinking more than 21 units per week (Nordqvist, 2015). His chronic back pain is showing to affect his physical activity and although an evaluation should be done to see its underlying cause, this is a typical finding in ascites (Health Reference Center, 2017). Ascites is an accumulation of fluid within the abdominal cavity, which is a common complication of cirrhosis. His diagnosis of hyperlipidemia may cause fat to gather in the liver and lead to worsening of the disease (NIH, 2017). His stressful living situation can have a negative impact, physically and mentally, to the body. Stress releases natural killer cells (NKT) that expand in the liver (Franciscus, 2015). This contributes to worsening of liver disease by causing cell death (Franciscus, 2015). Sometimes impaired blood flow can be detected by the part of the brain, controlling

Patient Y is a fifty nine year old widow, with a BMI of 29.0kg/m2 (severely overweight). Patient is currently unemployed and lives alone after the passing of her husband in 2008. Patient states that there is a strong family history of heart disease and confirms this by explaining that her father had died at the age of fifty after suffering from chronic heart failure for several years. Patient states that she drinks up to 24 units of alcohol a week and has prevalent past history of smoking.

The patient is married and lives with his wife in a suburban area. They have two children who are in good health who lives with their families. Patient is well established with family and friends as powerful support system; he experienced little stress. He has a master degree in engineer, and making decent money. He has no financial issues, and has great health insurance coverage. He does see his primary health care physician regularly. Patient lacks of knowledge on his health issues despite his high education in engineer. Patient does comply with his medication regimen and does not know the current resources available to him.

Based on 2014 hepatic encephalopathy guideline, NA’s hepatic encephalopathy is classified as type C and recurrent due to the cirrhosis and 2 episodes of HE occur with a time interval of 6 months or less. Typical signs and symptoms consistent with his HE includes confusion, forgetfulness, and anxiety. According to the guideline, the goals for the treatment are maintaining two to three bowel movements per day, decreasing elevated ammonia level, prevention of recurrent episodes of HE, and improvement of daily functioning. Lactulose is the first choice for treatment of overt HE. Currently, patient is on lactulose only once a day because of his noncompliance. The dose frequency is incorrect since he does not have at two to three bowel movements per day. Increasing frequency back to three times a day is recommended for the patient. Moreover, rifaximin is an effective add-on therapy to lactulose for prevention of OHE recurrence. Also, counseling the effects of lactulose and rifaximin, importance of adherence, early signs of recurring HE, and actions to be taken if recurrence are also beneficial for the patient.

This case study is about Abdul Chidiac, a 51 year old male, married with 4 children. He had a medical history of hypertension, hypercholesterolaemia and cirrhosis with two admissions in the last six months. He is a smoker and drinks beer, 5-6 bottles per day. As Carithers & McClain (2010) explained the patient’s medical history is another indicator of the risk for cirrhosis; the progression to cirrhosis is adaptable and may take time over weeks or many years. Cirrhosis is a liver disease characterized by permanent scarring of the

The medical evidence shows a chest CT taken on 9/2015 indicated the claimant was positive for mild atelectasis and mild fatty liver. The physical exam on 8/15 was normal. 5/15 he was positive for chronic heart failure with an ejection fraction of 565 and he

3:30 p.m.: Mr. B. arrives at triage accompanied by his son. Assessment results - B/P 120/80, HR-88 (regular), T-98.6, R-32, weight 175 pounds, pain 10/10, Left leg appears shortened with edema in the calf,

Cirrhosis is the 11th leading cause of death by disease in the United States. Almost one half of these are alcohol related. About 25,000 people die from cirrhosis each year.

The Excretory and Respiratory systems. The excretory system depends on the respiratory system to supply oxygen to the liver. The organ that completes this task is the lungs and its alveoli. Sadly, without the oxygen in the liver, we would eventually die from the urea poisoning the body. On the other hand, the respiratory system depends on excretory on the respiratory system to take some of the toxic, carbon dioxide. The liver combines mixes ammonia with carbon dioxide. Resulting in the creation of urea, which is additionally removed by the excretory system. Urea is much easier and less toxic to hold than ammonia

The patient is a licensed carpenter and is the sole provider for his household. He lives with his wife in a small apartment in an inner city. He admits that he does not get involved in physical activities due to unsafe neighborhood with high crime rate. He has no hobbies and prefer to read at home. He eats one large meal a day after work, misses breakfast majority of the times. He admits eating unhealthy meals for lunch, few serving of fruits and vegetables, and high- calorie food mostly pasta and meat at home. He does not engage in any street drugs or alcohol intake, however he admits smoking cigarette one pack per day for the past thirty years.

E.P. is an 88-year-old Caucasian male. He was admitted on 02/18/13. His code status is full code, and he declines to bring in his advanced directive. He reports that he is 68.5” tall, and his actual weight is 165 pounds. He and his wife are the sources of information, and they are reliable. His blood pressure is 124/62, taken on his right arm in a lying position, his oral temperature is 99.8, his right radial pulse is 74 beats per minute, his respiration rate is 16 breaths per minute and his pulse oximetry reading is 92 on room air. He is allergic to latex, cephalexin and sulfa drugs, with a reaction of hives, and to IV dye, with a reaction of moderate rash. He was