Vincent Miller, a 49-year-old accountant, has had a \"drinking problem\"througho
ID: 3517790 • Letter: V
Question
Vincent Miller, a 49-year-old accountant, has had a "drinking problem"throughout most of his adult life. He has been hospitalized on several occasions over the years. He reports dull pain in the right,upper quadrant of the abdomen,intermittent fever of 3 weeks duration, and a yellowing of the skin and the whites of the eyes. A diagnosis of "alcohol-induced hepatitis (liver inflammation)" is listed in the chart. With excessive intake of alcohol, the liver switches over from the use of fats and carbohydrates as its primary "fuel" to the use of alcohol as its primary fuel. This can lead to excessive production of lactic acid, which, in turn, can cause inflammation of the liver tissue.
1. Is the diagnosis consistent with the location of the abdominal pain? Explain your answer. How does this differ from circumstances of referred pain and what is the anatomical basis of visceral referred pain?
2. What is the physical relationship between the liver, gallbladder and duodenum? Be sure to include other organs that may share anatomical features.
3. If Vincent's liver disorder resulted in the production of a "gallstone," what danger might that present for his pancreas? Be specific.
Explanation / Answer
Answer 1. The location of the abdominal pain is consisted with the location of the liver that is right upper quadrant of the abdomen. This pain due to alcohol induced hepatitis is different from the reffered pain in the sense that reffered pain is dull and vague ,may sometime cause backache whereas the pain described in the question is localised pain. Reffered pain is due to ascites, abscess, cirrhosis and inflammatory etc. The anatomical basis of the visceral reffered pain is the stimulation of the pain receptors present in the visceral organs of the pelvis, thoracic and abdominal.
Answer 2. The liver, gall bladder and duodenum are related to each other functionally and anatomically.The bile is synthesised in the liver and stored in the gall bladder. The gall bladder opens in to the duodenum by bile duct to release the stored bile. When fatty foods comes in the duodenum the gall bladder contract to release its stored bile. Bile causes emulsification of the fatty foods and thus help in digestion.
Answer 3. If gall stone production occur in case of alcoholic hepatitis then it is very dangerous to pancreas.Due to presence of gall stones , chances of acute and chronic pancreatitis is high. Gall stones are predisposing factor for pancreatitis. This is due to blockage of bile duct and pancreatic duct by gallstones. This causes inflammation of pancreas or pancreatitis. The symtoms include abdominal pain and vomiting.
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