Computerized tomography

Computerized tomography may also be performed in order to determine the condition of the liver of the patient. However, this procedure may not be as precise as ultrasonography when the patient is only at its early stages of liver disease. Computerized tomography is also powerful in identifying nodules within the liver tissues, as well as determining atrophied regions. Magnetic resonance imaging is another imaging procedure that may be employed for screening patients with liver disease (Ito et al. , 1999). This procedure is generally employed during follow-up visits to the physician.

Magnetic resonance angiography is another procedure that can be employed to determine the features of blood flow in the liver. This procedure may determine whether a certain blood vessel is experiencing high pressure from the flow of blood. Magnetic resonance angiography is also sensitive enough in identifying blood clots or thromboses in portal veins of the liver. It should be understood that obstructions in the blood vessels that drain to and from the liver may cause severe medical conditions in the patient, including pancreatitis and liver failure.

It is also important that a liver biopsy be obtained from the patient in order to fully assess his condition. Although collecting a biopsy from the patient involves invasive procedures, the benefits go far beyond the discomfort that the patient may experience. It is important that a biopsy be collected because the tissue will serve as a reference as to what treatment regimens may be effective in taking care of the patient (Skelly et al. , 2001). It has been reported that the accuracy of a diagnosis go up to almost 100% if a biopsy has been collected from the patient (Abdi et al. , 1979).

The procedure of collecting a biopsy sample from the patient involves laparoscopy, which is a surgical procedure that involves making four incisions in the abdominal wall. Each one-inch incision allows different tubes and gadgets to be inserted into the abdominal cavity so that the surgeon and gastroenterologist may survey the liver and its surrounding organs. Laparoscopy also involves the insertion of a tube that is equipped with a small camera. This piece of equipment allows the physicians to literally view the liver and the surrounding tissue to see whether any tissues are damaged.

The other incision allows a tube to be put through which supplies carbon dioxide to be pumped into the abdominal cavity. The pumping of gas into the cavity allows the physicians to have more space to navigate the abdomen without much pressure from the rest of the organs of the digestive system. Laparoscopy is relatively safe and the patient is allowed to go home within the day. The incisions often heal within one to two weeks and there are minimal complications associated with the surgical procedure. One of the complications of cirrhosis of the liver is the presence of ascites, or fluid that has accumulated in the abdominal cavity.

When a patient has been determined to have ascites, it is suggested that a sample volume of this fluid be collected and analyzed with regards to levels of particular proteins. The ascetic fluid may also be subjected to culture in order to determine which particular type of antibiotic may be effective enough for administration to the patient. It is important that antibiotics be administered to a patient with ascites because there is a great chance that the patient has a bacterial infection due to the significant damage that has occurred to his body.

Ascitic fluid may also be assayed for albumin levels, which is a precise and reliable indicator for portal pressure. This amount of albumin in the ascitic fluid may be compared to the amount of albumin in the serum. The collection should be performed in the same day, in order to reach a sequential reading. If the amount of albumin in the ascitic fluid is higher than 1. 1 grams per deciliter, then this indicates that the patient is experiencing portal hypertension.

On the other hand, if the albumin concentration in the ascitic fluid is less than 1. 1 grams per deciliter, then other causes for ascites should be considered, such as peritonitis of the tubercles or cancer of the peritoneum. It is also important to determine whether a patient with characteristic ascites has polymorphonuclear leukocytes in the ascitic fluid (Cattau et al. , 2002). If the number of polymorphonuclear leukocytes is higher than 250 cells per cubic millimeter, then it is important that the patient be subjected to antibiotic treatment. The most common antibiotic employed for this condition is cefotaxime, which is usually administered through an intravenous line.

The optimal dose is 2 grams of cefotaxime for eight hours per administration. The patient may also be given albumin in order to prevent the possibility of peritonitis. The optimal dose for albumin is 1. 5 grams per kilogram body weight. Albumin should be administered every six hours. The alternative antibiotic treatment to cefotaxime is ofloxacin which may also be administered through an intravenous line (Heidelbaugh and Sherbondy, 2006). The optimal dose is 400 milligrams, at a frequency of twice a day.

It has been determined that most patients tolerate ofloxacin better than cefotaxime, where there are less cases of nausea and vomiting among patients. It is also possible to administer peritonitis to patients who have gone through peritonitis and need to be treated for long durations. Another antibiotic regimen that may be employed is norfloxacin sulfamethoxazole, which are also broad-range antibiotics. These antibiotics may be administered for an entire weeks and then discontinued afterwards. Portal hypertension is a common occurrence among patients with cirrhosis of the liver.

Since the pressure is significantly increased in the portal veins of the liver, the hepatic vessels are thus scarred and there is a great possibility that bleeding may occur. The bleeding may be observed in different regions of the digestive tract, from right below the esophagus to the stomach. The bleeding may be generally visualized during endoscopy (Foutch et al. , 1988). In addition, clotted blood may be transmitted to the stool and this has been observed in the stool sample of the patient.

Since blood is present in the patient’s stool sample, it is thus most probable that the patient is experiencing portal hypertension that is associated with cirrhosis of the liver (Pilette et al. , 1999). The 45-year old patient thus may have cirrhosis of the liver, as indicated by the results collected from laboratory samples of his blood, urine and stool. Additional tests should thus be performed in order to gather more information with regards to the stage of development of the cirrhosis. A liver biopsy will also be important in assessing the extent of damage that has accumulated in this patient’s liver.

The patient has a long history of alcohol abuse and coupling this information with the laboratory results, thus shows that it is most probable that the patient is experiencing cirrhosis of the liver. Pedal edema is also indicated for poor blood circulation and therefore fluid is retained in his lower extremities. The proper antibiotic treatment should thus be administered to the patient in order to prevent him from further deteriorating. References Abdi, W. , Millan, J. C. and Mezey, E. (1979). Sampling variability on percutaneous liver biopsy.

Archives in Internal Medicine, 139,667-669. American Gastroenterological Association. (2002). Medical position statement: Nonalcoholic fatty liver disease. Gastroenterology, 123,1702-1704. Cattau, E. L. Jr. , Benjamin, S. B. , Knuff, T. E. and Castell, D. O. (1982). The accuracy of the physical examination in the diagnosis of suspected ascites. JAMA, 247,1164-1166. Diehl, A. (2004). Alcoholic and nonalcoholic steatohepatitis. In: Goldman, L. and Ausiello, D. , eds. Cecil Textbook of Medicine, 22nd ed. Philadelphia, Pa. : Saunders. Pages 935-936.

Dufour, D. R. , Lott, J. A. , Nolte, F. S. , Gretch, D. R. , Koff, R. S. and Seeff, L. B. (2000a). Diagnosis and monitoring of hepatic injury. I. Performance characteristics of laboratory tests. Clinical Chemistry, 46,2027-2049. Dufour, D. R. , Lott, J. A. , Nolte, F. S. , Gretch, D. R. , Koff, R. S. and Seeff, L. B. (2000b). Diagnosis and monitoring of hepatic injury. II. Recommendations for use of laboratory tests in screening, diagnosis, and monitoring. Clinical Chemistry, 46,2050-2068. Foutch, P. G. , Sullivan, J. A. , Gaines, J. A. and Sanowski, R. A. (1988).

Cutaneous vascular spiders in cirrhotic patients: Correlation with hemorrhage from esophageal varices. American Journal of Gastroenterology, 83,723-726. Heidelbaugh, J. J. and Sherbondy, M. (2006). Cirrhosis and chronic liver failure. Part II: Complications and treatment. American Family Physician, 74,765-779. Ito, K. , Mitchell, D. G. , Hann, H. W. , Kim, Y. , Fujita, T. and Okazaki, H. (1999). Viral-induced cirrhosis: Grading of severity using MR imaging. American Journal of Roentgenology, 173,591-596.

Pilette, C. , Oberti, F. , Aube, C. , Rousselet, M. C. , Bedossa, P. and Gallois, Y. (1999). Non-invasive diagnosis of esophageal varices in chronic liver diseases. Journal of Hepatology, 31,867-873. Skelly, M. M. , James, P. D. and Ryder, S. D. (2001). Findings on liver biopsy to investigate abnormal liver function tests in the absence of diagnostic serology. Journal of Hepatology, 35,195-199. Simonovsky, V. (1999). The diagnosis of cirrhosis by high resolution ultrasound of the liver surface. British Journal of Radiology, 72,29-34.

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