Digestion Case Study
Name __Natalie Kennedy__________________________________________________
Patient: 42 year old male is presented in ER.
5’11inches
146 pounds
History of excessive alcohol consumption
Appears malnourished
Blood pressure: 96/76
H/H : 26% / 9 g
Heart rate 125bpm
Liver
Ascites
Bruising around arms
History: Patient has been vomiting for 2 days ( contains bright red blood) stool sample
indicated tarry dark blacken stools
Abdominal palpation indicated fluid in and around liver
Whites of eyes unclear
Patient has not been able to eat an appreciable amount of food for several weeks.
Diagnostic assessment: endoscopy and radiologic ultrasound examination
Finding indicate: gastric mucosal not inflamed, no ulcers, good motility, liver scarring,
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Alkaline phosphatase - slightly elevated.
Gamma-glutamyl transferase – correlates with AP levels. .
Bilirubin - may elevate.
Albumin - levels low
Prothrombin time - increased.
1. Examination result given a Child Pugh score as C- . What is this ? Propranolol
medication is prescribed. Why?
A child Pugh score is a test that examines the classification of severity of liver
malfunction in a patient. Plasma concentrations of bilirubin and albumin, the
prothrombin time all contribute to liver function. The scores range from A-C, with C
being the most severe of all scores. This means that the patient has decompensated
disease of the liver, where it is unable to compensate normal functions because of the
findings that are stated above, which alters liver function. Propranolol medication is
usually given to patients who are suffering from some form of heart failure. The patient
has a relatively high heart rate, so Propranolol is prescribed to slow down her heart rate.
It is a beta blocker drug that blocks the sympathetic nervous system stimulating the heart
to make contractions. It helps to slow down heart rate and decrease the force of
contractions in the heart to reduce heart rate.
2. Diagnosis: What do you suspect? State the suspected cause of the diagnosed
condition.
Stomach ulcers? Peptic ulcers?
It is assumed that the patient is suffering from cirrhosis of the liver. This is because it is
reported that the patient has liver scarring, which causes liver cirrhosis. Scar tissue on the
liver results when hepatocytes have been destroyed. It can be assumed that the patient’s
history of excessive consumption of alcohol is the reason why there is a chronic injury to
the hepatocytes of her liver. As a result, fibrous scar tissue surrounds isolated nodules of
new forming liver cells, which forms irreversible scars. The patients AP and GGT levels
are raised because her liver trying to rid the alcohol from the body. The patient is also
showing many symptoms and complications that accompany cirrhosis. The fluid in and
around her liver is a symptom called ascites. She is also showing signs of jaundice, which
explains why the white of her eyes are unclear. This results when the liver is unable to
eliminate bilirubin, which is why her bilirubin levels are increased. The scar tissue blocks
the bile ducts in the liver whose main purpose in digestion is to release bile into the
duodenum of the small intestine to emulsify fats. The reason why the patient is unable to
eat certain amounts of food is because the liver is barely functioning, which aids in the
digestion process. Her dark stool, vomiting, and weight may be contributory to peptic
ulcers which results from an imbalance in the mucosal lining and acidity in the stomach.
However, her endoscopy and ultrasound tests found no ulcers and a normal mucosal
lining in the stomach. The patient appears to be far from the early stages of cirrhosis and
many of the symptoms the patients is experiencing is a result from a great decline in her
liver functioning.
3. What accounts for:
 HH- the patient’s hemoglobin and hematocrit levels are low. This is because
hemoglobin and hematocrit is dependent upon plasma volume. It is established
that her albumins levels are lower than normal, so the H/H is low as well. Colloid
osmotic pressure is decreased and fluids aren’t being pulled back into the blood.
As a result, blood volume is low and there is not a sufficient amount of oxygen
being delivered to the tissues.
 Blood pressure – a slight hypotension is experienced by the patient due to her
progressed liver failure. A healthy liver compensates for lowered blood pressure
by releasing the hormone angiotenisen which is to be converted into angiotensin 1
by the renin enzyme, which intimates series of enzymatic reactions that will raise
blood pressure. Because of cirrhosis, the liver issuable to produce the substance to
maintain a homeostatic level of blood pressure.
 Heart rate- the high heart rate in the patient results from her heavy consumption of
alcohol. Alcohol dilates the arteries which will drop the blood pressure. The heart
compensates by increasing nerve signals sent from the sympathetic nervous
system to the heart which will cause the SA node to increase firing rate and
increase heart rate as a result.
 Bruising – The liver produces proteins that regulate blood clotting. The patient
has bruises because these proteins aren’t being produced as a result of the
cirrhosis.
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Fluid or third spacing (Ascites) - this is accumulation of fluid in the abdominal
cavity that develops when there is a decrease in albumin production. Because
albumin is produced by the liver, the patient’s albumin levels areas significantly
low because the liver is unable to produce a viable amount of albumin. Albumin
is the most abundant plasma protein that exerts osmotic pressure to maintain
blood volume and blood pressure. As a result, colloid osmotic pressure is
decreased, which allows fluid to flow form the interstitial spaces into the
peritoneal cavity where ascites are formed.
4. Back trace blood pathways, explain the bleeding.
The patient has been vomiting with blood and has dark stool. This is because of an
internal bleeding in the liver. The scar tissue blocks the hepatic portal venous system in
the liver. This blockage causes an increase of pressure in the portal vein. The portal vein
normally carries blood from the intestines and the spleen into the liver and into the
hepatic veins, then into the inferior vena cava. Instead of merging with the inferior vena
cava, blood flow throughout the liver is blocked. Blood is forced back into the splenic
vein, then the superior mesenteric vein, then into the inferior mesenteric vein in the
stomach and the esophagus. They are dilated until the point where they may rupture and
blood appears as a result.
5. Prognosis
A doctor can conclude that the patient is suffering form cirrhosis of the liver due to
overconsumption of alcohol. The severity in her case results from heavy amounts of
alcohol presented to her body overtime. The rate at which she consumes alcohol is
greater than the amount that liver is able to filter form the blood. Majority of the
symptoms of liver cirrhosis are present in the patient, which are previously discusses. All
these complications are present because she has had cirrhosis for a long time, and is now
in the stage that is very dangerous to many of the homeostatic imbalances in her body.
The disease may be fatal if she continues to live and allow her liver failure to progress. It
is recommended that the patient receives a liver trabnsplant as an attempt to save her life
and allow a healthy liver to bring her back to a healthy state.