Peggy Fender is well known to the emergency department (ED) staff. She\'s a 59-y

Question

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 afternoon, 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 9 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 alcohol 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 resuit of chronic inflammation of the liver fromm heavy, consistent alcohol.ingestion. If aicohol abuse continues long-term, it leads to f accumulation in the liver, followed by fibrosis and severe liver dysfunctionDS

Explanation / Answer

4) Peggy fendrer is an alcohol consumer it hurts the liver because the liver makes 6 clotting factors if even one decrease protrombin time is increased proving that the liver function is decreased. The bruising is due to unrepaired under the skin leakage.Hence the clooting time and bruising occurs even the hepatocytes are damaged.

5) A sinusoid is a smaller blood vessel that are similar to the cappilaries.The sinusoids are lined with the phagosytic cells called kupffer cells. These cells digest the old blood cells and clear the blood stream of toxins. Thus these unique strutures determine the function of an organ.

6) Increased resistance to hepatic or portal venous blood flow can lead to ascitis . Psychostomal periportal fibrosis is the cause in increase in venous pressure thus these is a cause for the increase in venous pressure cause the increase in net filtration in the hepatic cappilaries.

7) A decrease in onchotic pressure due to low albumin levels allow the fluid to leak. The increased capillary permiability is due to the burn damage of the liver.The forces that determine the net filtration pressure are

1) Glomerular hydrostatic pressure.

2) Glomerular plasma osmotic pressure

3) Glomerular filtration rate.

These are the forces that determine the net filtration pressure in the hepatic capillaries.

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