In advanced cirrhosis, the liver may actually shrink. The liver of patients with alcoholic hepatitis and cirrhosis is usually enlarged, palpable, and firm. Other symptoms that may occur include loss of libido in both sexes, gynecomastia in men, and menstrual irregularities in women. In advanced disease, the patient develops anorexia, nausea and vomiting, swelling of the abdomen and the lower extremities, and central nervous system symptoms related to the cirrhotic liver disease. Symptoms of early alcoholic liver disease include weakness, fatigue, and weight loss. Nodules of regenerated tissue form between fibrous bands, giving the liver a cobbled appearance. Cirrhosis is the disorganization of hepatic tissues caused by diffuse fibrosis and nodular regeneration. In women, a lower threshold of 20 to 40 g for the same period is average for the development of hepatitis. Men with alcoholic hepatitis usually consume at least 70 g of alcohol daily and have done so an average of 10 years. Alcoholic hepatitis is seen in approximately 30% of heavy drinkers. Cirrhosis is an irreversible inflammatory disease that disrupts liver structure and function. Many cases of cirrhosis of the liver are directly attributable to alcohol abuse, although infectious agents, particularly hepatitis C, are an emerging cause. Alcohol abuse is thought to be related to one in five hospitalizations in the United States. This patient has alcoholic hepatitis with cirrhosis of the liver. In addition, spider nevi are present over the upper part of the patient’s body. The patient’s liver edge is felt 6 cm below the right costal margin. There is a level of shifting dullness present. The patient has a significantly enlarged abdominal girth. He has a ruddy complexion and scleral icterus. On physical examination, you find a middle-aged man looking much older than his age. When you ask him if he drinks two 26-ounce bottles a day, he says, “Heck, no! I would never put away more than a bottle a day.” When you ask him what he drinks, he says vodka. You decide to pursue the question of drinking even further. When you pursue this line of questioning further and ask him what he means by being a social drinker, you find out that he drinks a few drinks before and after most meals plus a few drinks before he goes to bed. When you question the patient, he states that he is a social drinker. The patient’s wife is extremely concerned about his alcohol intake. When you question the patient, he states that his wife is overreacting. She states that during the past few weeks, the patient has eaten virtually nothing. In addition, he has gained 20 pounds in the past 3 weeks. His wife states that for the past several months, he has experienced extreme weakness and fatigue. Clinical Case Problem 1: A 50-Year-Old Man with AscitesĪ 50-year-old man is brought into your office by his wife.
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