The patient is a 56-year-old man who goes to his Primary Care Provider (PCP) complaining about moderate abdominal pain for the past two weeks. His medical history includes obesity, lifestyle-controlled diabetes mellitus, and arthritis. He had a past surgery to repair a femoral fracture in 1990, which needed a blood transfusion. He only takes over-the-counter acetaminophen for joint pain. He’s recently traveled to European and Southeast countries for work and reports not using any illicit drugs or tobacco products. However, after talking to his wife, she mentions that he drinks alcohol frequently.
Vital signs include:
A temperature of 97 °F.
A heart rate of 87 beats per minute.
A respiratory rate of 18 breaths per minute.
An oxygen saturation of 94%.
A blood pressure of 137/86 mm Hg.
The physical exam reveals the abdomen to be soft and protruding and multiple bruises on the lower parts of the body. The cardiac exam showed no discrepancies in the rate or rhythm. The PCP also noticed jaundice and spider-like blood vessels throughout the skin.
The lab work revealed a Complete Metabolic Panel (CMP) with total low protein and low albumin, indicating damage to the cells in the liver. The patient was positive for Hepatitis B surface antibodies and negativity for the rest of the tested antigens and antibodies. An abdominal ultrasound was conducted to see if there were lesions of the liver; the results showed portal hypertension, hypertrophy and atrophy of the liver, and modules on the surface of the liver. The liver tissue biopsy reveals inflammation and hepatocytes containing several fat droplets.
For treatment, the PCP recommended a low-sodium diet to prevent fluid buildup and blood pressure medications to control the pressure in the veins that supply to the liver. The PCP would also like the patient to follow up in the next couple of months to do an endoscopic gastroduodenoscopy (EGD) to see if there is any swelling in the veins in the esophagus. A liver transplant will be the last step if there is the liver does not show improvement.
Possible Conditions:
1. Cirrhosis: Cirrhosis is a chronic liver condition defined by scarring of the liver tissue. Risk factors like heavy alcohol consumption can increase the risk by reducing liver functions and destroying liver cells (hepatocytes). Symptoms can include upper abdominal pain, visible blood vessels that look like spiders, fatigue, loss of appetite, swelling in the abdomen, and easy bruising and bleeding. Treatment includes dieting to reduce sodium and further testing to see if there is more swelling in the future.
2. Liver Cancer: Liver cancer is defined as the uncontrolled growth of malignant cells in the liver that can spread to other organs if left untreated. A biopsy can reveal if cells in the liver are benign or not. Liver cancer symptoms include loss of appetite, pain in the upper abdomen, nausea and vomiting, unexplained weight loss, and enlargement of the liver. Treatment includes chemotherapy, and if not treated, liver cancer can lead to cirrhosis.
3. Hepatitis C: Hepatitis C is a viral infection that targets the liver, causing inflammation and swelling. This can damage the liver over time. Hepatitis C is caused by a virus that can be transmitted through contact with blood; the standard form of transmission is sharing needles. Some early warning symptoms of Hepatitis C include fever, fatigue, body aches, jaundice, abdominal pain, dark-colored urine and light-colored feces, and loss of appetite. Being positive for a Hepatitis B antibody can indicate previous exposure. Treatment can include Simeprevir and Sofosbivir, depending on the strain of the virus.
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Siri Nikku
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