Mr. L is a 55 year old builder. He has a long history of alcohol abuse and has been admitted to hospital for related reasons on many occasions in the past. His most recent hospital admission was for jaundice, progressive ankle swelling, abdominal distension and discomfort in the right upper quadrant of the abdomen. His alcohol intake over the past 10 years was estimated to average around 60 – 80 g / day. He was non compliant with medication following previous hospitalization and refused medical advice pursue a course of rehabilitation. He was admitted on this occasion with a history of vomiting a large amount of fresh blood. He has also noticed dark discolouration of his stools over the past week.
On examination he was jaundiced, had bilateral ankle oedema and severe ascitis. His mental functions were normal.
Lab tests:
Alanine aminotransferase (ALT): Elevated
Aspartate aminotransferase (AST): Elevated
Serum Albumin: Reduced
Prothrombin time: Elevated
Discussion Guidelines:
What are the risk factors for alcoholic liver disease (apart from downing the alcohol ofcourse!!)
Discuss the pathophysiological changes in the liver as a result of progressive alcohol intake.
What are the clinical scenarios associated with these changes?
Discuss the signs and symptoms of alcoholic cirrhosis and its complications.
Discuss the basis for the oedema, ascitis and jaundice in this patient.
Why did the patient present with vomiting fresh blood (haematemesis)?
What is the significance of the dark discolouration observed in his stools?
What lab investigations would you carry out in this patient?
Why is the Prothrombin time elevated?