- Upon Presentation A 65 Year Old Female Ella Jarvis Presents To Her Physician After An Episode Of Near Fainting And Pe 1 (62.59 KiB) Viewed 75 times
Ella Jarvis, 65-year-old Causasian female Her skin is cool, clammy and mild pallor with slight icterus (yellowing of skin). Heart rate is irregular and tachycardic and there is an S3 heart sound present. Jugular venous distension is present at 45 degrees. Bilateral +2-pitting edema is present. Question: On your CHEM 1005 Integrated Case Report document, list several findings that would be concerning in this initial presentation.
Ella is an attorney who has worked in private practice for 25 years. She estimates she works 70 hours/week between the office and the courtroom. She has attributed her persistent fatigue to her schedule, poor diet (“I usually eat on the run, whatever is available") and alcohol consumption (“I drink a bottle of wine a couple nights a week, and maybe more at the weekend especially if there are lots of dinners with clients"). Her fatigue has recently worsened and she has been feeling nauseous and light-headed consistently over the last several days. Ella work:
Ella states that she has not experienced any chest pain or pressure, palpitations or weakness of the extremities. This is the second incident of near-syncope in the past 6 months. She denies depression or anxiety but not feeling well has recently added to her normally high stress level. CA
Temp: 98.6 Height: 5'7" BP: 163/97 Weight: 184 Pulse: 140 BMI: 28.8 RR: 20 Pulse Ox (on room air): 92% V
A complete metabolic panel is ordered, and the results are below: Parameter Result Normal Glucose 87 70-99 mg/dL BUN 12 7-22 mg/dL. Creatinine 0.71 0.5-12 mg/dL. Na 141 135-145 mmol/L K 4.9 3.5-5.3 mmol/L CI 103 98-109 mmol/L CO2 24 22-26 mmol/L Calcium 9.2 8.6-10.2 mg/dL Phosphorus 2.7 2.6-4.9 mg/dL Albumin 3.0 3.2-46 g/dL Bilirubin 2.2 0.2-1.2 mg/dL. Lactate dehydrogenase (LDH) 190 99-191 IU/L Aspartate amino-transferase (AST) 260 12-45 IU/L Alanine aminotransferase (ALT) 76 <34 IU/L Alkaline Phosphatase 112 37-107 IU/L
Based on this information and patient history you have concerns of alcohol use disorder and recommend a liver biopsy. At this time Ella is also referred to cardiology for an EKG and cardiac evaluation A liver biopsy is performed and the following pathology is illustrated below. Pathology report: Alcohol-related steatosis consistent with small- and large-droplet fat. Fat accumulation is most prominent near the central vein (asterisk) and extends outward toward the portal tract with increasing severity. In this case, the fat extends into acinus zone 2 or the midzone of the hepatic lobule. Image source: https://aasldpubs.onlinelibrary.wiley.c ... ll/10.1002 /cld.172 Diagnosis This diagnosis is discussed with Ella and she wants to schedule a follow up to discuss her alcohol use, life-style modifications and counseling. InteractiveCase. Assignment Dromnt
Interactive Case: Assignment Prompt Describe how alcohol consumption contributes to the pathology presented in the image above. Be sure to address the key terms listed below as part of your discussion; you may address additional etiologies as well. • Acetoacetate • B-hydroxybutyrate • Ethanol metabolism • Gluconeogenesis • Fatty acid synthesis • Lipolysis . VLDL • Ketogenesis • NADH/NAD+ Complete this assignment using the CHEM 1005 Integrated Case Report Template, then submit as a Word Doc or PDF in Brightspace for grading by your instructor.
Alcohol Metabolism Case Study Make a copy (File > Make a Copy) of this document to record your answers as you complete the integrated case study. Part 1: • List several findings that would be concerning in this initial presentation. Part 2: • How do you interpret levels of glucose, BUN and albumin and what do they tell you about this presentation? • How do you interpret the increases in ALT, AST and LDH and what is the most likely cause of this? Part 3: • Describe how alcohol consumption contributes to the pathology presented in the image above. Be sure to address the key terms listed below as part of your discussion; you may address additional etiologies as well. Key terms: Acetoacetate; B-hydroxybutyrate; Ethanol metabolism; Gluconeogenesis; NADH/NAD+; Fatty acid synthesis; Lipolysis; VLDL; Ketogenesis