اسئلة تدريبية

Questions for training

A 45-year-old man who has drunk heavily for more than 5 years is admitted to hospital for intensive medical care. The patient had been suffered from fever, upper abdominal discomfort, nausea, vomiting and darkening of his urine for a week. His condition markedly deteriorated and he became drowsy just few hours before admission. Clinical examination revealed yellowish sclera with tender hepatomegaly. A provisional diagnosis of acute hepatitis was given for his condition.

What is the most likely cause of his deterioration? Mention some other features (signs and symptoms) of this complication.
If the provisional diagnosis is correct, mention at least 3 causes that may be responsible for this illness.
What are laboratory tests that establish alcohol misuse is the sole cause for his current illness?
If the answer C is positive and the patient is recovered completely from his illness; what is the best advice one can offer to him in order to avoid future liver problems?
Mention 3 groups of liver problems that are linked with alcohol consumption.

Answers:

In the presence of features of acute hepatitis, it is worthy to think about the possibility of acute hepatic encephalopathy (acute liver failure) as a cause of his drowsiness. Earlier to drowsiness the patient may develop a beheviour or mood changes, restlessness, anxiety, and disturbance of sleep pattern. Later the patient may develop confusion and coma. He also prone to develop numerous other psychological and neurological features like epileptic fits, pupil changes, flapping tremor, musty breath odour, signs of increased intracranial pressure, changes in reflexesetc.
Causes of viral hepatitis include: viral (A, B, D. E). Alcohol, drugs. Hereditary like Wilson diseaseetc.
Liver function test typically shows an AST/ALT > 1, but S. AST level in general is not exceeding 300 U/L. Unlike viral hepatitis CBC may show neutrophilic leukocytosis rather than lymphocytosis. Macrocytosis in absence of anaemia. GGT also may raised in alcoholic liver disease. Negative viral serology. Unexplained rib fractures, particularly bilateral, on a chest X-ray are also suggestive of alcohol misuse.
Life-long alcohol abstinence is the best advice for the patient.

Alcoholic fatty liver disease.

Alcoholic hepatitis (acute and chronic).
Liver cirrhosis.