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Patient case: Cirrhosis of the Liver

Patient case: Cirrhosis of the Liver

Discussion

Name: MT

Age: 58 years

Gender: Male

Occupation: Accountant

History: The patient has a long history of heavy alcohol consumption (approximately 10-12 drinks per day) for the past 25 years. He has a past medical history of hypertension, which is poorly controlled. His family history is significant for liver disease and hypertension.

Presenting Complaint: MT presents to the clinic with complaints of increasing fatigue, a sense of bloating, and a loss of appetite for the past 3 months. He has also noticed swelling in his legs, which has progressively worsened, and some abdominal distension. He reports intermittent nausea and occasional vomiting but denies any significant abdominal pain.

Physical Examination: On examination, MT is alert and oriented but appears fatigued. His skin shows signs of mild jaundice, and his sclerae are slightly yellow. He has significant ascites, with a positive fluid wave test. His lower legs are swollen, and there are signs of spider angiomas on his chest. The liver is palpated to be enlarged and firm, but there is no tenderness on palpation. His blood pressure is elevated at 150/90 mmHg, and he has a mildly elevated heart rate.

Investigations:

Laboratory tests:

Elevated liver enzymes (ALT: 120 IU/L, AST: 145 IU/L)

Elevated bilirubin (Total: 2.5 mg/dL, Direct: 1.5 mg/dL)

Prolonged prothrombin time (INR: 1.5)

Low albumin (2.2 g/dL)

Low platelet count (120,000/mm³)

Hemoglobin: 12.5 g/dL

Imaging: 

Ultrasound shows a shrunken, nodular liver with signs of portal hypertension and ascites.

Diagnosis: MT is diagnosed with cirrhosis of the liver, likely secondary to alcohol use and possible underlying non-alcoholic fatty liver disease (NAFLD).

Management: The treatment plan includes:

Alcohol cessation and counseling support

Diuretics (spironolactone) for ascites management

Beta-blockers (propranolol) for portal hypertension

Regular monitoring of liver function and screening for esophageal varices

Nutritional support and vitamin supplementation

Hepatitis screening for possible coexisting viral infections

Follow-Up: MT is scheduled for regular follow-up visits to monitor his liver function, ascites, and any complications of cirrhosis.

Questions
1. What is the most likely diagnosis for MT, given his history and symptoms?

A) Hepatitis B

B) Non-alcoholic fatty liver disease

C) Alcoholic Cirrhosis

D) Acute liver failure

2. What is the primary risk factor contributing to MT's liver disease?

A) Hypertension

B) Excessive alcohol consumption

C) Diabetes

D) Hepatitis C infection

3. Which of the following is the most appropriate first-line management for Michael's ascites in alcoholic cirrhosis?

A) Antibiotics

B) Diuretics

C) Liver transplant

D) Vitamin supplements

4. Which complication of cirrhosis is most concerning in this case?

A) Hepatic encephalopathy

B) Portal hypertension

C) Hepatocellular carcinoma

D) Fatty liver disease

Reveal answers

Answers

1. C) Alcoholic Cirrhosis

• Given the history of chronic alcohol use, ascites, and other clinical signs, alcoholic cirrhosis is the most likely diagnosis.

2. B) Excessive alcohol consumption

• Michael’s long history of alcohol consumption is the main contributing factor to his liver disease.

3. B) Diuretics

• Diuretics are the first-line treatment for ascites in patients with cirrhosis to manage fluid retention.

4. B) Portal hypertension

• Portal hypertension is a common and dangerous complication in cirrhosis, leading to ascites and other severe outcomes.