Peggy Fender is well known to the emergency department (ED) staff. She\'s a 59-y

Question

Peggy Fender is well known to the emergency department (ED) staff. She's a 59-year-old woman whose visit today is similar to her frequent visits in the past. She arrives in the afternoon, appearing intoxicated and complaining of abdominal pain, particularly in the right upper quadrant (RUQ) of her abdominopelvic cavity. "Another Fender bender," a nearby nurse whispers to Tim, the new physician assistant (PA) who is due to examine Mrs. Fender.

Tim proceeds with his physical examination. Mrs. Fender appears emaciated with bruising of various ages on her arms, legs, and face. She is jaundiced (yellow-skinned) and has the strong smell of alcohol on her breath. Tim palpates the inferior border of her liver, which is hard and enlarged; Mrs. Fender moans with pain. Her entire abdomen is ascitic (swollen and fluid-filled). Mrs. Fender is not entirely coherent; she knows where she is and who she is, but is unable to relate anything about her present illness except a slurred, "My stomach hurts; quit poking it, you idiot!" Her coordination is poor when she attempts to sit or stand. She becomes annoyed and indignant when Tim asks her how much alcohol she's had to drink today even though she is obviously inebriated.

Tim reviews her blood tests, which reveal elevated blood transaminases (liver enzymes), high blood glucose (hyperglycemia), and prolonged prothrombin time (PT - slowed clotting time). Based on her history, and present findings, Tim diagnoses Mrs. Fender with alcoholic cirrhosis, which is the result of chronic inflammation of the liver from heavy, consistent alcohol ingestion. If alcohol abuse continues long-term, it leads to fat accumulation in the liver, followed by fibrosis and severe liver dysfunction.

Question: Besides the nurse's "bender" comment, and Mrs. Fender's social history, Tim suspects alcohol abuse based on many of his physical exam findings. Name at least three signs and/or symptoms that point to alcoholism, and briefly explain why each sign/symptom may occur.

Explanation / Answer

Name three signs and/or symptoms that point to alcoholism:

i) Elevated blood transaminases (liver enzymes): The elevated level of liver enzymes like aspartate transaminase and alanine transaminase indicates the liver damage. These enzymes were mainly found in liver but their high amount in blood shows the damaged condition of liver.

ii) Prolonged prothrombin time: As the cloting factors were formed in livers so in the condition of cirrhosis they were not fomed or in formed in very low concentration so the collting takes a long time. This condition also arises due to long term use of alcohol.

iii)  Cirrhosis involves replacement of the normal hepatic parenchyma with extensive thick bands of fibrous tissue and regenerative nodules, which results in the clinical manifestations of portal hypertension and liver failure.

iv) Poor coordination: Alcohol imparts bad effects on cerebellum of brain which results in poor coordination between brain and muscle cells.

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