Reference no: EM132379210
Explain the pathophysiological mechanisms through which alcohol-induced cirrhosis leads to ascitis, relating them -when appropriate- to the functions of the liver.
Case scenario attached below.
Case history and initial presentation
Paramedics are dispatched to the home of Andrew Cavanagh, 52 years old, who has collapsed after vomiting blood. When they arrive at the house, they are led to the bathroom by the patient's wife, Lisa. Andrew is lying on his side on the floor near the toilet, breathing quietly. He doesn't respond to anyone speaking to him and only groans in response to one of the paramedics squeezing his trapezius muscle. He has blood on his face and in his mouth, and there is a large amount of bright red blood in the toilet and splattered on the surrounding floor.
Lisa tells the paramedics that her husband has been drinking beer all evening, as he has done for most of his adult life. He felt sick and went to the bathroom, she heard him violently vomiting and then heard him collapse. Andrew was diagnosed with cirrhosis 6 years ago.
Physical Examination
Vital signs survey and physical examination reveals:
- Pulse rate 136 bpm, weak
- BP 80/50 mmHg
- Temperature 37.0oC
- Respiratory rate 18 breaths/min
- SpO2 97%
- GCS 7
- Skin is pale, with a yellowish tinge, diaphoretic
- Yellow sclera were noted when the patient opened his eyes in response to pain
- Moderate amount of ascites
- Distended abdominal wall veins around the umbilicus
The paramedics establish IV access, administer IV crystalloid fluids, manage the patient's airway, and rapidly transport him to hospital.