What is the correct name for the hand flapping condition

Reference no: EM133604527

ASSIGNMENT:

Mr. R, a 58 year old male, presented to the ED in a rural area. He states "I'm tired all the time, and I threw up blood." He reports having bright red blood in his emesis last night around midnight. He also reported abdominal discomfort as aching and burning, being worse in the morning hours, and that eating, chewing antacids, and taking Pepcid makes the pain tolerable. Mr. R. states he has not had a good appetite and reports that although he has a large stomach, he has lost weight over the past year and feels weak. He denies night sweats of fevers, skin problems or rashes, but reports he has noticed some red "blotches" over his chest and stomach. He reports foul smelling diarrhea stools.

On admission, Mr. R. is confused, conjunctiva and skin are slightly jaundice with sunken eyes. The NP notices bruises, distended abdominal veins, abdominal ascites, umbilicus protruding with caput medusae extending from center and downward, hand flapping, and clubbing. The NP also noted an abnormal breath odor, which she described as smelling like ammonia. Mr. R, has slightly enlarged breasts, thin lower extremities with muscle wasting. Multiple spider angiomas were noted over abdomen and chest areas. Clubbing, decreased body hair, palmar erythema, testicular atrophy, and internal rectal hemorrhoids were also noted.

Mr. R. lab work revealed:

Albumin - 2.1
Total protein - 4.1
Bilirubin - 2.8
Sodium - 128
Potassium - 3.2
Glucose - 140
Platelets - 120

A. What is Mr. R's diagnosis? What factors support your diagnosis? Discuss the pathophysiology of Mr. R's disease.

B. Do you expect Mr. R to have a high or low BP? Explain the rationale for your answer.

C. What is the correct name for the hand flapping condition? What are the red "blotches" over his chest and stomach?

D. Discuss the pathophysiology of Mr. R's mental confusion.

E. Other than decreased appetite, explain why Mr. R. continues to lose weight, although he has ascites?

F. Identify each of the abnormal lab values above and discuss the rationale for the abnormality.

Reference no: EM133604527

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