Case study - cirrhosis

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Pagana: Mosby’s Manual of Diagnostic and Laboratory Tests, 6th Edition

Cirrhosis

Case Studies

The patient was a 48-year-old man with a history of former drug abuse who presented to the

emergency room with abdominal swelling, lethargy, anorexia, and hemoptysis. On physical

examination, he was noted to have mild ascites and was somewhat obtunded.

Studies Results

Alanine aminotransferase

(ALT), p. 36

178 International units/L (normal: 5–35 International

units/L)

Alkaline phosphatase (ALP), p.

130 units/L (normal: 30–85 units/L)

Aspartate aminotransferase

(AST), p. 107

176 International units/L (normal: 5–40 International

units/L)

Lactate dehydrogenase (LDH),

p. 293

240 International units/L (normal: 45–90 International

units/L)

Gamma-glutamyl transpeptidase

(GGTP), p. 221

33 International units/L (normal: 8–38 International

units/L)

Ammonia, p. 53 348 mg/dL (15–110 mg/dL)

Computed tomography (CT)

scan of liver, p. 962

Shrunken fibrotic liver compatible with cirrhosis

Liver biopsy, p. 685 Posthepatitis cirrhosis

Hepatitis profile, p. 256 All negative, except HBVc-Ab

Esophagoscopy, p. 547 Esophageal varices

Diagnostic Analysis

The patient presented with cirrhosis and ascites. His elevated liver enzymes were compatible

with liver cellular disease. His elevated ammonia level indicated that he was susceptible to

encephalopathy. The patient was somewhat obtunded. He was bleeding from his esophageal

varices, and the blood in the gut increased the load on his liver’s capability to metabolize protein.

He became progressively encephalopathic. His coagulation studies were probably prolonged,

thereby contributing to his esophageal bleeding. The cause of his cirrhosis could have been prior

hepatitis B (HBV) infection. The acute phase sometimes goes unrecognized. He may have

contracted the virus from a contaminated needle. He had no serologic evidence of acute

infection. The HBVc-Ab indicated a previous infection.

Unfortunately, the patient became progressively encephalopathic and expired during this

hospitalization.

Critical Thinking Questions

Case Studies

1. Why do you think the coagulation studies would be elevated?

2. How are the ammonia results related to encephalopathy?

3. Can you explain the abdominal swelling in this patient?