Booze Blues: A Case on the Liver Peggy Fender is well known to the emergency dep

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Booze Blues: A Case on the Liver Peggy Fender is well known to the emergency department (ED) staff She's a 59-year-old woman whose visit today is similar to her frequent visits in the past. She arrives in the aftemoon, appearing intoxicated and complaining of abdominal pain, particularly in the right upper quadrant (RUQ) of her abdominopelvic cavity. "Another Fender bender,"a nearby nurse whispers to Tim, the new physician assistant (PA) who is due to examine Mrs. Fender. Tim proceeds with his physical examination. Mrs. Fender appears emaciated with bruising of various ages on her arms, legs, and face. She is jaundiced (yellow-skinned) and has the strong smell of alcohol on her breath. Tim palpates the inferior border of her liver, which is hard and enlarged; Mrs. Fender moans with pain. Her entire abdomen is ascitic (swollen and fluid-filled). Mrs. Fender is not entirely coherent; she knows where she is and who she is, but is unable to relate anything about her present illness except a slurred, "My stomach hurts; quit poking it, you idiot!" Her coordination is poor when she attempts to sit or stand. She becomes annoyed and indignant when Tim asks her how much alcobol she's had to drink today even though she is obviously inebriated. Tim reviews her blood tests, which reveal elevated blood transaminases (liver enzymes), high blood glucose (hyperglycemia), and prolonged prothrombin time (PT-slowed clotting time). Based on her history.and present findings, Tim diagnoses Mrs. Fender with alcoholic cirrhosis, which is the result of chronic inflammation of the liver from heavy, consistent alcohol ingestion. If aicohol abuse continues long-term, it leads to fat accumulation in-the liver, followed by fibrosis and severe-liver dysfunction. 1. Besides the nurse's "bender" comment, and Mrs. Fender's social history, Tim suspects alcohol abuse based on many of his physical exam findings. Name at least three signs and/or symptoms that point to alcoholism, and briefly explain why each sign/symptom may occur. The liver is known for its ability to remove certain toxins from the blood. It can perform this function because its cells, or hepatocytes, contain large quantities of lysosomes and peroxisomes, and also have an extensive smooth endoplasmic reticulum. Briefly describe how these three organelles contribute to this major function of the liver 2. Mrs. Fender's jaundice is caused by the accumulation of bilirubin in her blood and tissues. What is the normal fate of bilirubin, and what role does the liver play? Explain how Mrs. Fender's cirrhosis is related to her jaundice. 3.

Explanation / Answer

Q1> Signs/symptoms of alcoholism

a> Intoxicated apperance: Alcohol is a CNS depressant and can cause specific apperance of the patient

b> Strong alcoholic breath: Practically highly useful sign to confirm alcoholic consumption

c> Ascites and hepatomegaly: In chronic alcoholism there is inflammation and degeneration of hepatocytes and liver tissues,

In long standing cases there will be Portal hypertension leading to accumulation of fluid in peritoneal cavity(Ascites)

Q2>

Functions of following orgenelles in detoxification:

works via lysosomal enzymes

takes part in detoxification by the action of lysosomal enzymes

endoplasmic reticulum that is devoid of ribosomes are known as smooth endoplasmic reticulum.

they can form steroid hormone and take part in alcohol detoxyfication

they are associated with cytochrome systems

Name of the orgenelle How they take part in detoxification Lysosome

works via lysosomal enzymes

takes part in detoxification by the action of lysosomal enzymes

Peroxisome detoxes alcohol by peroxidative reaction smooth endoplasmic reticulum

endoplasmic reticulum that is devoid of ribosomes are known as smooth endoplasmic reticulum.

they can form steroid hormone and take part in alcohol detoxyfication

they are associated with cytochrome systems

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