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Alcohol-related Cirrhosis: Mr. Cherry

Among the alcohol-related liver diseases, alcohol-related cirrhosis is considered to be the most severe disease (Terai et al, 2016, p. 2295). This is because after contracting this disease, the river becomes scarred and this condition is permanent leading to the failure of the liver. Ascites refers to the abnormal accumulation of fluids in the abdominal cavity. According to research, alcoholic cirrhosis leads to ascites (Amitrano et al, 2014, p. 739). Mr Cherry has a medical history of ascites and alcohol-related cirrhosis. Some of the signs and symptoms that Mr Cherry shows include a distended abdomen with decreased bowel sounds in all the four quadrants and liver enlargement thus becoming firm with sharp ends. Other symptoms include frequent incidences of anorexia, indigestion and diarrhea alternating with constipation. Mr Cherry also complains of being extraordinarily tired after minimum exercise like walking a hundred meters. The subsequent literature outlines how alcoholic cirrhosis results in the above signs and symptoms, the significance of his laboratory results, the purpose of the prescribed medication, some of the most common adverse events that are likely to occur from the prescribed medication and the potential drug-drug and drug-food interactions for his prescribed medications.

Indigestion

Indigestion due to strong cirrhosis results from several factors associated with gut dysfunction. This affects the nutrition status of an individual. Additionally, indigestion may result from reduced food intake arising from alcoholic cirrhosis.

Constipation alternating with diarrhea

This is a type of irritable bowel syndrome. Liver damage causes several changes in bowel movements. Constipation refers to the impaction of bowel movements that harden in the lower part of the abdomen making it difficult to pass. A patient suffering from alcoholic cirrhosis experiences bowel movement as a result of liver damage which then leads to constipation.

Anorexia

Anorexia is a common problem especially in patients with advanced cirrhosis (Dakanalis et al, 2016, p. 16026). This leads to malnutrition. Reasons for his reduced food intake include hepatocellular failure and tense ascites which lead to difficulties in feeding.

Unusual tiredness

Unusual fatigue is a common symptom for most people with liver disease regardless of the cause (Quarneti et al, 2015, p. 637). The pathogenesis of fatigue in liver cirrhosis is poorly planned. However, this unusual fatigue can be explained because the liver is forced to work extra for a long duration of time resulting in this unusual tiredness. Additionally, this unusual fatigue is associated with performing mental as well as physical activities that require self-motivation.

Large liver with a sharp edge

In the beginning stages of cirrhosis, the liver tends to be large because the cells are loaded with fat (Askgaard et al, 2015, p. 1066). As a result, the liver becomes firm with a sharp edge noticeable on palpation. Abdominal pain may occur due to the rapid enlargement of the liver producing tension on the fibrous cover of the liver. Later on in the course of the disease a scar tissue contracts the liver tissue, the edge of the liver becomes modular.

Distended abdomen with decreased bowel sounds

A distended abdomen is caused by the accumulation of fluid in the abdominal cavity (Chiu & Shen, 2017, p. 255). This may further limit the patient’s ability to eat, perform daily activities and also ambulate.

Blood glucose: 5.7mmol/

For a normal person, the level of blood glucose should range between 4.0mmol/L and 5.4mmol/L when fasting and up to 7.8mmol/L two hours after eating (Dall et al, 2014, p. 3177). However, for a person who has diabetes, this level ranges from 4 to7 before a meal and up to 9 two hours after meals. At 5.7mmol/L, this implies that Mr Cherry’s cirrhotic liver cannot respond to insulin thus exposing him to the risk of contracting diabetes type 2. Insulin is defined as a hormone that is produced by the pancreases to aid in regulating the level of glucose in a human being.

Total leukocyte count: 8,000 cell/mm^3

For a normal person, the total number of leukocytes should range from 4000 cell/mm^3 to 4,500 cell/mm^3 (Welsh et al, 2018, p. 1417). Anything below this range indicates that your body is not able to fight infections while any count above this range implies that the body is fighting with a certain infection. At 8,000 cell/mm^3, this implies that Mr Cherry’s body is experiencing increased production of leukocytes to fight alcoholic cirrhosis or it is reacting to the high level of insulin in the body.

Activated coagulation time: 140

Activated coagulation time refers to the amount of time that an individual’s blood to form a clot (Zilberman-Rudenko at al. 2016, p. 511). For a normal person, this time should range from 70 to 120 especially without heparin while this time changes from 80 to 240 seconds with heparin. At 140 seconds, Mr Cherry’s activated coagulation time implies that his blood contains heparin thus his blood takes longer to clot. This implies that Mr Cherry is at high risk of contracting anemia due to excessive bleeding.

Hematocrit: 39%

Hematocrit refers to the ratio of the red blood cells’ volume to the blood’s total volume (Sano, Takei, Shiraishi & Suzuki, 2016, p. 844). In men, this ratio should range from 42% to 52% while in women, this ratio should range from 37% to 47%. At 39%, Mr Cherry’s level of haematocrit indicates that he is at high risk of contracting anemia since his ratio is below the normal ratio.

Prothrombin time with INR: 4.0

This is a test that helps doctors in evaluating a person’s ability to form clots after a cut (Matchar et al, 2015, p. 17). The normal ratio of prothrombin time with INR should range between 0.8 and 1.1. At 4, Mr Cherry’s ratio is high above the normal hence his blood cannot clot easily.

Partial thromboplastin time: 78 seconds

This is a blood test used in evaluating the time taken for a person’s blood to form a clot. For a normal person, this time should range from 25 seconds to 35 seconds (Morishima & Kamisato, 2015, p. 245). Referring to the case of Mr Cherry, a partial thromboplastin time of 78 seconds is above the normal. This implies that in case Mr Cherry develops a cut, his blood may take longer to clot thus exposing him to the risk of excessive bleeding.

Total bilirubin: 24.3 micromol/L

Total bilirubin refers to a blood test used in measuring the level of bilirubin in a person’s blood (Kunutsor et al, 2015, p. 721). For a healthy person above the age of 18 years, this amount should be 1.2 micromol/L. This implies that Mr Cherry’s total bilirubin is above the normal amount that exposing him to the risk of acquiring jaundice.

Total serum calcium: 2.26 mmol/L

Total serum calcium refers to the total amount of free and bound calcium in the body (Akboga et al, 2015, p. 113). For a normal person, the level of total serum calcium should range between 8.5-10.2 mmol/L. This implies that at 2.26 mmol/L, Mr Cherry’s level of total serum calcium is below the normal level thus exposing him to hypocalcemia.

Serum potassium: 4.1 mEql/L

This implies that Mr Cherry is not at risk of contracting hyperkalemia as his level of potassium is in the normal range. For a normal person, the level should be range between 3.5 4.1 mEql/L and 5.0 4.1 mEql/L (Pitt et al, 2015, p. 1061).

Serum sodium: 134 mEql/L

Serum sodium helps in maintaining normal levels of blood pressure, supporting the work of the muscles and nerves and regulating the body’s fluid balance. At normal levels, serum sodium should range 135-145 mEql/L. This implies that at 134 mEql/L, Mr Cherry’s serum sodium was below the normal levels thus exposing him to the risk of contracting hyponatremia.

Platelet count: 100, 000mm^3

For a normal person, platelet count should range between 150,000mm3 to 450,000mm^3 (Stratz et al, 2016, p. 291). This implies that Mr Cherry’s platelet count is above the normal count. This implies that he is at risk of contracting thrombocytopenia.

Serum creatinine: 220 micromol/L

At normal levels, the level of Serum creatinine should range from o.6 to milligrams per deciliter (Kellum et al, 2015, p. 2237). Mr Cherry’s elevated level of serum creatinine implies he is likely to be suffering from kidney failure or malfunction.

Blood urea nitrogen: 6.8 mmol/L

This is a medication that is used in measuring the amount of urea nitrogen in the blood. For a normal human being, the level of blood urea nitrogen should range from 6 to 20 mmol/L (Weintraub, Blanco, Barnes & Green, 2015, p. 52). This implies that Mr Cherry’s level of blood urea nitrogen is normal.

Serum globulin 6.1g/L

This is one of the proteins in a human’s body (Li et al, 2015, p. 2856). Mr Cherry’s low protein levels indicate that he is suffering from liver disease. For a normal person, the level of serum globulin should range between 20g/L and 35 g/L. This implies that Mr Cherry’s level of serum globulin is below the normal level.

Serum albumin: 22g/L

This is one of the most abundant proteins found in a human being. For a normal person, the level of serum should range from 20 grams to 35 grams per litre (Wu, Yan, Wang, Wang & Li, 2015, p. 427). This implies that at 22g/L, Mr Cherry’s level of serum albumin is normal.

Alanine transaminase: 56U/L

This is an enzyme found in the cells of the kidney and the liver (Chao et al, 2015, p. 351). For a normal person, the level should be between 10 and 40 units per litre. In the case of Mr Cherry, the elevated level signifies that he is experiencing liver damage.

Aspartate transaminase: 54U/L

Aspartate transaminase refers to an enzyme released when the muscles or the liver is damaged (Robertson et al, 2016, p. 329). For a normal person, the level should be 7-56U/L. Mr Cherry’s elevated level signifies some form of liver injury or damage.

Alkaline phosphate: 288 U/L

Alkaline phosphate refers to an enzyme in the blood of a person that helps in the process of breaking down proteins (Sheen et al, 2015, p. 831). For a normal person, the level should be between 20-140 units per litre. In the case of Mr Cherry, this level is too high, and he is at risk of contracting medical conditions relating to the liver.

Purposes of the Prescribed Medication

Spironolactone (Aldactone) 100mg po daily – the purpose of this medication is to help Mr Cherry in removing excess fluid from his body.

IV infusion 0.9% NaCl 500ml loaded with B-Dose 2ml injection of folic acid 15mg injection – the purpose of this medication is to help in delivering fluid placement throughout Mr Cherry’s body to help in easing constipation.

Thiamine 100mg po daily after IV infusion is ceased - the purpose of this type of medication is to help the patient’s body cells convert carbohydrates into energy

Mylanta 20ml po qid – this is a type of medication that is used to treat different symptoms of too much acid in the stomach such as indigestion, heartburn and stomach upset. In the case of Mr Cherry, this medication was prescribed to help in treating indigestion.

Pheniramine maleate (Avil) 1tablet pot ds – this type of medication is used in the process of treating various allergic conditions like skin rashes, itching skin, running nose and hay fever (Huang et al., 2014, p. 7). Regarding Mr Cherry’s situation, this type of medication was prescribed to help in treating itching skin.

Folic acid 1,000 mcg po daily after IV infusion is ceased – the purpose of this type of medicine is to help Mr Cherry in the production of more red blood cells.

Common Adverse Events of the Prescribed Medications

Examples of adverse of the prescribed medications include numbness, dry mouth, drowsy, uneven heartbeat, muscle pain, erectile dysfunction, headache, dizziness, stomach pain, gynecomastia in men and breast pain among women, blood clots as well as post-menopausal virginal bleeding and irregular menstrual periods (McHutchison et al, 2017, p. 2231). Other events include blurred vision, widened pupils, eye redness, rashes, thrush, diarrhea, vomiting and nausea, poor appetite, bloating, funny taste in the mouth, tenderness, sweating and feeling restless.

The potential drug-drug and drug-food interactions for his prescribed medications

Drug-food interactions – this refers to a condition that occurs when a patient’s medicine and food interfere with each other (Yamreudeewong et al. 2015, p. 381). Referring to the case of Mr Cherry, the drug-food interaction may occur due to the consumption of various food while still taking the prescribed medications. Some of these foods include foods that are heavily laced with salt, sugary treats such as baked goods, soda, cakes and cookies and saturated fats and especially those found in fried foods, fatty pieces of meat, high-fat dairy foods, sour cream and butter.

Drug-drug interactions – this is a type of interaction that occures when a patient changes the type of drug that he has been taking or when a drug is taken together with another drug (Köhler et al. 2016, p. 511). Mr Cherry should avoid taking other drugs apart from the ones prescribed by the doctor.

 

 

 

 

 

 

 

 

 

 

 

 

Reference

Akboga, M. K., Canpolat, U., Sahinarslan, A., Alsancak, Y., Nurkoc, S., Aras, D., ... & Abaci, A. (2015). Association of serum total bilirubin level with severity of coronary atherosclerosis is linked to systemic inflammation. Atherosclerosis240(1), 110-114.

Amitrano, L., Guardascione, M. A., Brancaccio, V., Margaglione, M., Manguso, F., Iannaccone, L., ... & Balzano, A. (2014). Risk factors and clinical presentation of portal vein thrombosis in patients with liver cirrhosis. Journal of hepatology40(5), 736-741.

Askgaard, G., Grønbæk, M., Kjær, M. S., Tjønneland, A., & Tolstrup, J. S. (2015). Alcohol drinking pattern and risk of alcoholic liver cirrhosis: a prospective cohort study. Journal of hepatology62(5), 1061-1067.

Chao, D. T., Lim, J. K., Ayoub, W. S., Nguyen, L. H., & Nguyen, M. H. (2014). Systematic review with meta‐analysis: the proportion of chronic hepatitis B patients with normal alanine transaminase≤ 40 IU/L and significant hepatic fibrosis. Alimentary pharmacology & therapeutics39(4), 349-358.

Chiu, Y. H., & Shen, C. H. (2017). Fixed abdominal air. QJM: An International Journal of Medicine110(4), 255-255.

Dakanalis, A., Gaudio, S., Serino, S., Clerici, M., Carrà, G., & Riva, G. (2016). Body-image distortion in anorexia nervosa. Nature Reviews Disease Primers2(3), 16026.

Dall, T. M., Yang, W., Halder, P., Pang, B., Massoudi, M., Wintfeld, N., ... & Hogan, P. F. (2014). The economic burden of elevated blood glucose levels in 2012: diagnosed and undiagnosed diabetes, gestational diabetes mellitus, and prediabetes. Diabetes care37(12), 3172-3179.

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Tags: Health Writing, Prescribed Medication, Serum Globulin

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