Pathophysiology of disease: case study

The most probable diagnosis for the 54-year-old patient is that he has cirrhosis of the liver. This disorder has been observed to be asymptomatic, wherein signs are not apparent unless the individual suddenly changes in his routine behavior. In this case study, the patient vomited blood or experienced haematemesis, after working with heavy materials. The heavy lifting is associated with his job as a construction worker. The general source of the blood that the patient vomited is from the upper region of the gastrointestinal tract.

Cirrhosis of the liver can be diagnosed from a combination of different examinations, including physical, as well as laboratory assays and radiological assessments. The medical history of the patient also provides information on the medical disorder of the patient. In the case of the 54-year old construction worker who was initially subjected to physical examination, he was discovered to be underweight by approximately 10 kg. Physical assessment of the patient also revealed that he was experiencing dehydration. The patient also showed signs of confusion.

Upon palpation of the abdominal region, the patient’s liver was observed to be enlarged and rigid. The medical history of the patient also included alcohol abuse, which is one of the most frequent causes of liver cirrhosis. Other causes of cirrhosis of the liver include infection with hepatitis C and gross obesity (AGA, 2002). The patient was also reported to run a fever of 42oC upon presentation at the hospital, indicating that the patient was experiencing some form of inflammation, which correlates to the enlarged liver. Pedal oedema is also a common sign of liver cirrhosis (Diehl, 2004).

Given these physical examination results, it is thus important to review the results of the laboratory tests. One of the laboratory tests that were conducted was the determination of the serum levels of aspartate aminotransferase (AST). This enzyme is secreted by the muscle tissues of the body and may be elevated during conditions when damage to the liver is occurring (Dufour et al. , 2000a). The AST assay is considered as a test for assessing the functioning of the liver. In cases wherein the liver is inflamed, the AST levels are usually found to be elevated and this was observed in the test results of the patient.

Another similar enzyme that can be employed in assessing a patient with possible cirrhosis of the liver is alanine aminotransferase (ALT). This enzyme, on the other hand, is generated by the liver cells, or hepatocytes. The ALT assay is also considered as one of the tests that can be employed to check for liver function, yet there may be less information that could be gather when collecting serum from the patient. It has been established that the levels of the ALT enzyme is elevated when the liver is damaged or inflamed.

It is also possible that the ALT enzyme levels are high when the hepatocytes are dead. When the hepatocytes are damaged, the ALT enzymes that are produced in these cells are released and by these cells and enter the bloodstream. It should be understood that the ALT enzyme is not a specific indicator for cirrhosis of the liver. This enzyme is also employed in screening for hepatitis, which have a variety of etiologic factors such as viral infection and drug abuse. Both AST and ALT levels are commonly observed to be at high concentrations when the liver is inflamed.

The amount of AST and ALT are usually found in a 1:1 ratio. During conditions such as hepatitis caused by alcohol abuse, the level of serum AST is generally higher than the level of serum ALT. The laboratory test of the patient also showed that his serum alkaline phosphatase level was elevated. Alkaline phosphatase pertains to an enzyme that is generated in the bile ducts (Dufour et al. , 2000b). The enzyme is also secreted in the intestinal tract, as well as the kidney. It is also possible for the placental tissue and the bones to produce alkaline phosphatase.

An elevated level of this enzyme can indicate that the patient has a disorder that is related to the bile ducts. It should be understood that the bile duct is a drainage system that allows the gall bladder to introduce bile during digestion. The bile duct is also connected to the liver and thus any damage or obstruction to this duct system will prevent the normal physiology of the liver. The results of the patient that showed an elevated alkaline phosphatase level may be coupled to the elevated level of AST. The combined results of having both enzyme levels elevated may strongly indicate that the patient has cirrhosis of the liver.

The test result of the patient for bilirubin showed the amount of 85 mol/l, when the normal bilirubin level should only be 20 mol/l. Bilirubin is a product of the degradation of old erythrocytes, or red blood cells. The liver is responsible in removing bilirubin from the bloodstream through a mechanism known as conjugation. The removal is followed by its transfer into the bile, which in turn is moved to the intestinal region of the digestive tract. Part of the bilirubin may also be reabsorbed back into the bloodstream through diffusion through the intestinal wall.

The laboratory test of the patient showing an elevated level of bilirubin in the blood indicates that the liver is not functioning properly because it is not able to remove bilirubin from the bloodstream. It may also be possible that bilirubin levels are high in an individual if the body is producing significantly large amounts of this protein, at higher levels than what is considered normal. Another probable reason for elevated levels of bilirubin in the blood is the decreased amount of conjugation of bilirubin before its transfer into the bile.

Elevated levels of bilirubin may also result from an obstruction in the bile ducts, thus hampering the removal of bilirubin from the bloodstream. Since elevated bilirubin levels are indicators for a number of medical conditions, the results should thus be coupled to the results of the alkaline phosphatase tests. When both bilirubin and alkaline phosphatase levels of a patient are high, then it is most probably due to the cirrhosis of the liver. In this 45-year old patient, both bilirubin and alkaline phosphatase levels are elevated. It is also helpful if an ultrasound of the abdominal region of the patient were performed.

This is a non-invasive procedure that provides information of the gross characteristics of the liver. This procedure may also provide information on the blood flow along the essential vascular ducts of the liver. Ultrasonography is generally considered as the prime radiographic procedure that is employed to assess the liver of a patient and to check for signs of cirrhosis (Simonovsky, 1999). The procedure is relatively safe because it only employs sound waves that emit resonating vibrations that produce an image of the liver and any other organs that need to be evaluated.

Ultrasonography also provides information regarding nodes and any other irregular features that might be present in the liver of the patient. It is also possible to identify any regions of the liver that are undergoing atrophication. When a patient is in an advanced stage of liver disease, ultrasonography results will shows a highly nodular liver. In addition, the blood flow of the liver will be significantly lower than normal. It has been determined that ultrasonography provides a 94% sensitivity in detecting nodules within the liver and thus this procedure offers high sensitivity and prediction with regards to liver conditions.

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