Presentation is loading. Please wait.

Presentation is loading. Please wait.

Case Study 18: Cirrhosis Skylar Strobel.

Published byMillicent Jenkins Modified over 9 years ago

Similar presentations

Presentation on theme: "Case Study 18: Cirrhosis Skylar Strobel."— Presentation transcript:

1 Case Study 18: Cirrhosis Skylar Strobel

2 Overview Role of liver Scar tissue forms as liver repairs itself
Wide range of causes Liver plays a role in digestion through the production of bile, detoxifies chemicals, metabolizes drugs and makes proteins

3 Patient S.G. 46 yo white male History of chronic alcoholism
Abdominal swelling and confusion Gained 15 lbs Lethargic, acting strangely

4 PMH Cirrhosis, 4 years ago H/O: Father died at age 52
Uncontrolled ascites and peripheral edema Anemia Acute pancreatitis E. coli-induced bacterial peritonitis Father died at age 52 H/O alcohol abuse H/O IVDA and intranasal cocaine ½ ppd for many years Ascites-build of fluid in the lining between the abdomen and abdominal organs

5 Review of Systems Increasing abdominal girth
No complaints of abdominal pain, fever, chills, nausea, hematemesis, tarry stools, cough, chest pain, weakness, blood in urine, diarrhea or dry mouth

6 Patient Case Question 1: Hematemesis and tarry stools are clinical signs of which serious potential complication of cirrhosis? Hematemesis = vomiting of blood Acute gastrointestinal bleeding

7 Physical Exam Skin HEENT Chest Abdomen Genit/Rect Neuro Mild jaundice
(+) spider nevi on chest (-) palmar erythema Several ecchymoses on lower extremities HEENT (+) icteric sclera Chest (+) gynecomastia Abdomen Moderately distended, firm, slightly tender (+) prominent veins (+) HSM Genit/Rect Testicles atrophied (+) hemorrhoids Neuro Confused, disoriented

8 Patient Case Question 2: Identify 15 clinical signs and symptoms consistent with a diagnosis of cirrhosis

9 Unusual violent behavior Skin
Weight gain Lethargy Confusion Unusual violent behavior Skin Mild jaundice (+) spider nevi on chest Several ecchymoses on lower extremities HEENT (+) icteric sclera Chest (+) gynecomastia Abdomen Moderately distended, firm, slightly tender (+) prominent veins (+) HSM Genit/Rect Testicles atrophied (+) hemorrhoids Neuro Confused, disoriented

10 Lab Test Results Na 135 meq/L WBC 4700/mm3 Mg 1.7 mg/dL K 3.5 meq/L
PT sec AFP ng/mL Cl meq/L PTT sec HBsAg (-) HCO meq/L NH µg/dL HIV (-) BUN mg/dL AST IU/L Anti-HCV (+) Cr mg/dL ALT IU/L HCV RNA 2.8 million/mL Glu mg/dL Alk phos IU/L ANA (-) Hb g/dL Bilirubin mg/dL Fe µg/dL Hct % Protein g/dL Ferratin ng/mL MCV fL Alb g/dL Transferrin saturation 38% Plt /mm3 Ca mg/dL Ceruplasmin mg/dL

11 3. Anemic? Na 135 meq/L WBC 4700/mm3 Mg 1.7 mg/dL K 3.5 meq/L
PT sec AFP ng/mL Cl meq/L PTT sec HBsAg (-) HCO meq/L NH µg/dL HIV (-) BUN mg/dL AST IU/L Anti-HCV (+) Cr mg/dL ALT IU/L HCV RNA 2.8 million/mL Glu mg/dL Alk phos IU/L ANA (-) Hb g/dL Bilirubin mg/dL Fe µg/dL Hct % Protein g/dL Ferratin ng/mL MCV fL Alb g/dL Transferrin saturation 38% Plt /mm3 Ca mg/dL Ceruplasmin mg/dL Look at hemoglobin, hematocrit, MCV, platelets and WBC Then look at iron in the blood

12 4. Abnormality of CBC? Na 135 meq/L WBC 4700/mm3 Mg 1.7 mg/dL
K meq/L PT sec AFP ng/mL Cl meq/L PTT sec HBsAg (-) HCO meq/L NH µg/dL HIV (-) BUN mg/dL AST IU/L Anti-HCV (+) Cr mg/dL ALT IU/L HCV RNA 2.8 million/mL Glu mg/dL Alk phos IU/L ANA (-) Hb g/dL Bilirubin mg/dL Fe µg/dL Hct % Protein g/dL Ferratin ng/mL MCV fL Alb g/dL Transferrin saturation 38% Plt /mm3 Ca mg/dL Ceruplasmin mg/dL Super low platelet count – lower range is around 150,000

13 5. Sudden progression? Na 135 meq/L WBC 4700/mm3 Mg 1.7 mg/dL
K meq/L PT sec AFP ng/mL Cl meq/L PTT sec HBsAg (-) HCO meq/L NH µg/dL HIV (-) BUN mg/dL AST IU/L Anti-HCV (+) Cr mg/dL ALT IU/L HCV RNA 2.8 million/mL Glu mg/dL Alk phos IU/L ANA (-) Hb g/dL Bilirubin mg/dL Fe µg/dL Hct % Protein g/dL Ferratin ng/mL MCV fL Alb g/dL Transferrin saturation 38% Plt /mm3 Ca mg/dL Ceruplasmin mg/dL

14 6. Four risk factors Alcohol Abuse Hepatitis C Overweight Liver Cancer
Anti-HCV test + Overweight Height: 5’7” Weight: 171 lbs BMI = 26.8  overweight Liver Cancer AFP test – 90 ng/mL Normal – 0-15 ng/mL

15 7. Bacterial peritonitis?
Na meq/L WBC /mm3 Mg mg/dL K meq/L PT sec AFP ng/mL Cl meq/L PTT sec HBsAg (-) HCO meq/L NH µg/dL HIV (-) BUN mg/dL AST IU/L Anti-HCV (+) Cr mg/dL ALT IU/L HCV RNA 2.8 million/mL Glu mg/dL Alk phos IU/L ANA (-) Hb g/dL Bilirubin mg/dL Fe µg/dL Hct % Protein g/dL Ferratin ng/mL MCV fL Alb g/dL Transferrin saturation 38% Plt /mm3 Ca mg/dL Ceruplasmin mg/dL To diagnose: high WBC, protein greater than 1g/dL, glucose less than 50 mg/dL

16 8. Why do an ANA test? Na 135 meq/L WBC 4700/mm3 Mg 1.7 mg/dL
K meq/L PT sec AFP ng/mL Cl meq/L PTT sec HBsAg (-) HCO meq/L NH µg/dL HIV (-) BUN mg/dL AST IU/L Anti-HCV (+) Cr mg/dL ALT IU/L HCV RNA 2.8 million/mL Glu mg/dL Alk phos IU/L ANA (-) Hb g/dL Bilirubin mg/dL Fe µg/dL Hct % Protein g/dL Ferratin ng/mL MCV fL Alb g/dL Transferrin saturation 38% Plt /mm3 Ca mg/dL Ceruplasmin mg/dL ANA-antinuclear antibodies, may help find autoimmune chronic hepatitis, could cause cirrhosis

17 9. Hemochromatosis? Na 135 meq/L WBC 4700/mm3 Mg 1.7 mg/dL K 3.5 meq/L
PT sec AFP ng/mL Cl meq/L PTT sec HBsAg (-) HCO meq/L NH µg/dL HIV (-) BUN mg/dL AST IU/L Anti-HCV (+) Cr mg/dL ALT IU/L HCV RNA 2.8 million/mL Glu mg/dL Alk phos IU/L ANA (-) Hb g/dL Bilirubin mg/dL Fe µg/dL Hct % Protein g/dL Ferratin ng/mL MCV fL Alb g/dL Transferrin saturation 38% Plt /mm3 Ca mg/dL Ceruplasmin mg/dL Means there is too much iron in the body, iron overload, all are WNL

18 10. Wilson’s disease? Na 135 meq/L WBC 4700/mm3 Mg 1.7 mg/dL
K meq/L PT sec AFP ng/mL Cl meq/L PTT sec HBsAg (-) HCO meq/L NH µg/dL HIV (-) BUN mg/dL AST IU/L Anti-HCV (-) Cr mg/dL ALT IU/L HCV RNA 2.8 million/mL Glu mg/dL Alk phos IU/L ANA (-) Hb g/dL Bilirubin mg/dL Fe µg/dL Hct % Protein g/dL Ferratin ng/mL MCV fL Alb g/dL Transferrin saturation 38% Plt /mm3 Ca mg/dL Ceruplasmin mg/dL Inherited, too much copper in body’s tissues, normal limits

19 11. Why can autoimmune hepatitis and primary biliary cirrhosis be ruled out as contributing factors to this patient’s condition? Because both are autoimmune disorders but the ANA was normal

20 Transferrin saturation 38% Plt 34500/mm3 Ca 8.5 mg/dL
Na meq/L WBC /mm3 Mg mg/dL K meq/L PT sec AFP ng/mL Cl meq/L PTT sec HBsAg (-) HCO meq/L NH µg/dL HIV (-) BUN mg/dL AST IU/L Anti-HCV (-) Cr mg/dL ALT IU/L HCV RNA 2.8 million/mL Glu mg/dL Alk phos IU/L ANA (-) Hb g/dL Bilirubin mg/dL Fe µg/dL Hct % Protein g/dL Ferratin ng/mL MCV fL Alb g/dL Transferrin saturation 38% Plt /mm3 Ca mg/dL Ceruplasmin mg/dL Both are autoimmune dieases, but tested negative for ANAs

21 12. Osteoporosis? Na 135 meq/L WBC 4700/mm3 Mg 1.7 mg/dL K 3.5 meq/L
PT sec AFP ng/mL Cl meq/L PTT sec HBsAg (-) HCO meq/L NH µg/dL HIV (-) BUN mg/dL AST IU/L Anti-HCV (-) Cr mg/dL ALT IU/L HCV RNA 2.8 million/mL Glu mg/dL Alk phos IU/L ANA (-) Hb g/dL Bilirubin mg/dL Fe µg/dL Hct % Protein g/dL Ferratin ng/mL MCV fL Alb g/dL Transferrin saturation 38% Plt /mm3 Ca mg/dL Ceruplasmin mg/dL

22 13. Evidence for ascites Na 135 meq/L WBC 4700/mm3 Mg 1.7 mg/dL
K meq/L PT sec AFP ng/mL Cl meq/L PTT sec HBsAg (-) HCO meq/L NH µg/dL HIV (-) BUN mg/dL AST IU/L Anti-HCV (-) Cr mg/dL ALT IU/L HCV RNA 2.8 million/mL Glu mg/dL Alk phos IU/L ANA (-) Hb g/dL Bilirubin mg/dL Fe µg/dL Hct % Protein g/dL Ferratin ng/mL MCV fL Alb g/dL Transferrin saturation 38% Plt /mm3 Ca mg/dL Ceruplasmin mg/dL Alb low, protein high – indicative of the presence of ascites

23 14. Hepatic encephalopathy?
Na meq/L WBC /mm3 Mg mg/dL K meq/L PT sec AFP ng/mL Cl meq/L PTT sec HBsAg (-) HCO meq/L NH µg/dL HIV (-) BUN mg/dL AST IU/L Anti-HCV (-) Cr mg/dL ALT IU/L HCV RNA 2.8 million/mL Glu mg/dL Alk phos IU/L ANA (-) Hb g/dL Bilirubin mg/dL Fe µg/dL Hct % Protein g/dL Ferratin ng/mL MCV fL Alb g/dL Transferrin saturation 38% Plt /mm3 Ca mg/dL Ceruplasmin mg/dL Worsening of brain function that occurs when liver is no longer able to remove toxic substances in the blood, primary indicator is ammonia Nh3 VERY high, 18-60ug/dL

24 15. Grade this encephalopathy?
0: Minimal HE Hard to detect, changes in memory, concentration and temper are minimal 1: Mild HE Short attention span, noticeable mood changes, sleep problems 2: Moderate HE Forgetfulness worsens, lethargic, exhibit inappropriate behavior, slurred speech, and difficulty with mental tasks 3: Severe HE Confused as to where you are or what day it is, extremely sleepy, unable to do basic mental tasks, extremely anxious, act strangely 4: Coma Unconscious, slip into coma

25 16. Patient’s CTP score? Na 135 meq/L WBC 4700/mm3 Mg 1.7 mg/dL
K meq/L PT sec AFP ng/mL Cl meq/L PTT sec HBsAg (-) HCO meq/L NH µg/dL HIV (-) BUN mg/dL AST IU/L Anti-HCV (-) Cr mg/dL ALT IU/L HCV RNA 2.8 million/mL Glu mg/dL Alk phos IU/L ANA (-) Hb g/dL Bilirubin mg/dL Fe µg/dL Hct % Protein g/dL Ferratin ng/mL MCV fL Alb g/dL Transferrin saturation 38% Plt /mm3 Ca mg/dL Ceruplasmin mg/dL Child-Pugh Score used to assess prognosis of chronic liver disease, mainly cirrhosis, look at these lab rseults, then grade ascites and encephatholgy grade to obtain the score (online calculator) Score = 12, Class C, life expectancy of 1-3 years

26 17. One year survival? Based on his class C CTP score, this patient has a 45% probability of surviving another year

27 18. Does the patient have any signs of dehydration or hepatorenal syndrome?

28 Transferrin saturation 38% Plt 34500/mm3 Ca 8.5 mg/dL
Na meq/L WBC /mm3 Mg mg/dL K meq/L PT sec AFP ng/mL Cl meq/L PTT sec HBsAg (-) HCO meq/L NH µg/dL HIV (-) BUN mg/dL AST IU/L Anti-HCV (-) Cr mg/dL ALT IU/L HCV RNA 2.8 million/mL Glu mg/dL Alk phos IU/L ANA (-) Hb g/dL Bilirubin mg/dL Fe µg/dL Hct % Protein g/dL Ferratin ng/mL MCV fL Alb g/dL Transferrin saturation 38% Plt /mm3 Ca mg/dL Ceruplasmin mg/dL Dehydration look at electrolytes, and hepatorenal syndrome = rapid deterioration in kidney function inidividuals with cirrhosis, look at BUN and Cr

29 19. The patient’s primary care provider has decided to conduct extensive clinical studies for the diagnosis of liver cancer. Which single abnormal laboratory value has raised a concern that hepatocellular carcinoma may have developed?

30 Transferrin saturation 38% Plt 34500/mm3 Ca 8.5 mg/dL
Na meq/L WBC /mm3 Mg mg/dL K meq/L PT sec AFP ng/mL Cl meq/L PTT sec HBsAg (-) HCO meq/L NH µg/dL HIV (-) BUN mg/dL AST IU/L Anti-HCV (-) Cr mg/dL ALT IU/L HCV RNA 2.8 million/mL Glu mg/dL Alk phos IU/L ANA (-) Hb g/dL Bilirubin mg/dL Fe µg/dL Hct % Protein g/dL Ferratin ng/mL MCV fL Alb g/dL Transferrin saturation 38% Plt /mm3 Ca mg/dL Ceruplasmin mg/dL AFP-alpha-fetoprotein, tumor marker, helps in the diagnosis of liver cancers

Download ppt "Case Study 18: Cirrhosis Skylar Strobel."

Similar presentations

Hepatocirrhosis Liver cirrhosis.

Hepatocirrhosis Liver cirrhosis.
Dr. Gehan Mohamed Dr. Abdelaty Shawky

Dr. Gehan Mohamed Dr. Abdelaty Shawky
GASTROINTESTINAL Pathology I January 9, 2014. Gastrointestinal Pathology I Case 1.

GASTROINTESTINAL Pathology I January 9, Gastrointestinal Pathology I Case 1.
Approach to a patient with jaundice

Approach to a patient with jaundice
Prepared by: Tristan Villanueva Arcibal BSN-RN Presented on: July 16, 2013 A CASE PRESENTATION OF A PATIENT WITH DIABETIC KETOACIDOCIS (DKA)

Prepared by: Tristan Villanueva Arcibal BSN-RN Presented on: July 16, 2013 A CASE PRESENTATION OF A PATIENT WITH DIABETIC KETOACIDOCIS (DKA)
Chronic Liver Disease Simon Lynes. Definition Progressive destruction and regeneration of the liver parenchyma leading to fibrosis and cirrhosis.

Chronic Liver Disease Simon Lynes. Definition Progressive destruction and regeneration of the liver parenchyma leading to fibrosis and cirrhosis.
Nawal Raja Marianne Estrada Angelica Bengochea Period 0

Nawal Raja Marianne Estrada Angelica Bengochea Period 0
Pancreatitis Acute pancreatitis. Definition Is an inflamation of the pancreas ranging from mild edema to extensive hemorrhage the structure and function.

Pancreatitis Acute pancreatitis. Definition Is an inflamation of the pancreas ranging from mild edema to extensive hemorrhage the structure and function.
Case study Mr. Wang, a 64-year-old male, presented with nausea and coffee ground emesis in your department. In the past 1 month, he suffered from recurrent.

Case study Mr. Wang, a 64-year-old male, presented with nausea and coffee ground emesis in your department. In the past 1 month, he suffered from recurrent.
Unusual Tanning By Chris Sanders.

Unusual Tanning By Chris Sanders.
Common abdominal syndromes. Gastroesophageal reflux disease - GERD n History: heartburn, chest pain, regurgitation, acidic taste in mouth, dysphagia,

Common abdominal syndromes. Gastroesophageal reflux disease - GERD n History: heartburn, chest pain, regurgitation, acidic taste in mouth, dysphagia,
Medical Grand Rounds Clinical Vignette Matthias C. Kugler, M.D. Internal Medicine Resident 09-12-2008.

Medical Grand Rounds Clinical Vignette Matthias C. Kugler, M.D. Internal Medicine Resident
LIVER PATHOLOGY LAB MHD II January 20, 2015. Case 1 Describe the low power findings.

LIVER PATHOLOGY LAB MHD II January 20, Case 1 Describe the low power findings.
CDI Education Cirrhosis 4/17/2017.

CDI Education Cirrhosis 4/17/2017.
Benign Prostatic Hyperplasia. BPH  Benign increase in size of prostate  Hyperplasia of stromal and epithelial cells  Nodules.

Benign Prostatic Hyperplasia. BPH  Benign increase in size of prostate  Hyperplasia of stromal and epithelial cells  Nodules.
Cirrhosis of the Liver Kayla Shoaf.

Cirrhosis of the Liver Kayla Shoaf.
Liver failure.

Liver failure.
Liver pathology: CIRRHOSIS

Liver pathology: CIRRHOSIS
Liver Cirrhosis S. Diana Garcia

Liver Cirrhosis S. Diana Garcia
Acute Liver Failure. 30 year old woman presents to hospital with a two day history of nausea, vomiting, and right upper quadrant pain. She has been healthy.

Acute Liver Failure. 30 year old woman presents to hospital with a two day history of nausea, vomiting, and right upper quadrant pain. She has been healthy.

Similar presentations

Ads by Google