Vincent Miller, a 49-year-old accountant, has had a \"drinking problem\" through
ID: 3517819 • 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
1. Yes, theajor part of liver is located on the right upper abdomen so any pathology of liver may present as right upper quadrant pain of abdomen.
Refered pain is pain of any organ that is felt on other location and not directly on the skin over that organ. The basis - the organ and the skin or dermatome have same nerve supply.
2. Liver secrete bile which is stored in gall bladder and then released into duodenum. Liver is connected to gall bladder by hepatic duct which then join duct from gall bladder to form common bile duct. CBD then join Pancreatic duct and form common Hepatopancreatic duct which finally open into duodenum. Thus pancreas also have anatomical connection with duodenum.
3. Pancreatitis - when gall bladder stone block the lumen of pancreatic or Hepatopancreatic duct then pancreatic enzyme are not able to go to duodenum. This enzyme gets back into pancreas and lead to pancreatitis.
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