Class Case Study - Cirrhosis of the Liver Patient Summary: Onset of disease: History: Terri Wilcox is a 26-year-old arch
Posted: Wed Apr 20, 2022 8:34 am
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Class Case Study - Cirrhosis of the Liver Patient Summary: Onset of disease: History: Terri Wilcox is a 26-year-old architecture doctoral student who was in relatively good health until 3 years ago when she was diagnosed with hepatitis C. Hepatitis C DX 3 years ago Previously treated with alpha-interferon and ribavirin; seasonal allergies treated with antihistamines She c/o fatigue, anorexia, N/V, and weakness. She has lost 4.54kg since her last office visit, which was 6 months ago. She also reports that she has been experiencing bruising of her skin that did not happen previously and does not appear to be related to injury. Allegra 60 mg po qd Medical history: Medication at home: Family history: Chief complaint: Vital Signs: HEENT: Mother (living)-HTN, diverticulitis, cholecystitis, carpal tunnel syndrome; father (deceased)-diabetes mellitus, peptic ulcer disease; maternal grandmother-cholecystitis, bilateral breast cancer; maternal grandfather-leukemia; paternal grandfather-cirrhosis; paternal grandmother-amyotrophic lateral sclerosis. "It just seems as if I can't get enough rest. I feel so weak. Sometimes I'm so tired, I can't go to campus to teach my classes. Does my skin look yellow to you?" Tired-looking young female. Temp: 36.1°C Pulse: 72 bpm Resp rate: 19 bpm BP: 102/65 Height: 172.72cm Weight: 56.7kg Heart: Regular rate and rhythm, no gallops or rubs, point of maximal impulse at the fifth intercostal space in the midclavicular line Eyes: Wears contact lenses to correct myopia; PERRLA Ears: Tympanic membranes w/out lesions Nose: Dry mucous membranes w/out lesions Throat: Enlarged esophageal veins Pierced umbilicus, upper right abdomen; mild distension, hepatomegaly; no ascites CT scan of liver and biopsy Test stool for occult blood Daily 1/0 Spironolactone 25 mg qid Propranolol 40 mg bid Soft, high-kcal, high-protein diet-small, frequent meals Multivitamin/mineral supplement; Bed rest Abdomen: Orders:
Cirrhosis-MELD score 23 Diagnosis: Laboratory Results Ref. Range 12/19 1012 Chemistry Sodium (mEq/L) Potassium (mEq/L) Chloride (mEq/L) Carbon dioxide (CO2, mEq/L) BUN (mg/dL) 136-145 3.5-5.5 95-105 23-30 8-18 136 5.0 102 28 21 !1 12/19 1012 14 ! 115 11 3.6 2.1 93 3.7 If 5.4 ! 21 11 15 !! 33 275 11 62 it 230 11 138 1 Laboratory Results (Continued Ref. Rango Creatinine serum (mg/dL.) 0.6-12 Glucose (mg/dL) 70-110 Phosphate, inorganic (mg/dL) 23-4.7 Magnesium (mg/dL) 1.9-3 Calcium (mg/dL) 9-11 Bilirubin, direct img/dL) 203 Protoin, total (g/dL) 69 Albumin (gd) 35-5 Proalbumin (mgldL) 16 35 Ammonia (NH. umoll) 933 Alkaline phosphatase (UL) 30-120 AT (UK) 436 AST (UL) 0-35 CPK (UL 30-135 F 55-170 M Lactate dehydrogenase (U/L) 208-378 Cholesterol (mg/dL) 120-199 HDLC (mg/du .55 F, .45 M LDL (moldu 130 Triglyceridas (mg/dL.) 35-135 F 40-160 M HbA.c(%) 3.9-52 Coagulation (Coag) PT (sec) 124-14.4 INR 0.9-11 PTT (Soc) 24 34 Homatology WBC 13 10'/mm) 4.9-11.8 RBC 13 10 mm") 4.2-5.4 F 4.5-62M Hemoglobin (Hgb. ad 12-15 F 14-17 M Homatocrit Hct, %) 37-47 F 40 54 M 658 11 199 50 !! 125 256 If 4.9 18.5 11 2.2 ! 41 11 4.8 4.1 11 10.9 ! 35.91
Laboratory Results (Continued Mean cell volume (um") Mean cell Hgb (pg) Mean cell Hgb content [g/dL Platelet count (310/mm) Ferritin (mg/ mL Ref. Range 80-96 26-32 315-36 140-440 20-120F 20-300 M 24.4-100 5-25 12/19 1012 94 29 35.4 342 120 100 25 Vitamin B. Indo Folate (no/db Hematology, Manual Diff Lymphocyte (%) Monocyte (%) Eosinophil (%) Segs (%) Urinalysis Collection method 15-45 3-10 0-6 0 60 20.6 4.2. 28 51 Color Appearance Specific gravity pH Protein (mg/dL) Glucose (mg.du Ketones Occult blood Bilirubin Nitrites Urobilinogen (EU/ Leukocyte esterase Prot chk WBCs VHPF) RBCs VHPF) 1.003-1.030 5-7 Neg Neg Neg Neg Neg Neg . 11 Neg Neg 05 0-5 random Specimen dark slightly hazy 1.025 5.9 11 ! Neg Nog Neg 11 11 Neg 18 !! Nog Nog 38 2.7
1. After reading this patient's history and physical, identify her signs and symptoms (5) consistent with her diagnosis. (0.2 x 5 = 1.0) 2. Ms. Wilcox's doctor notes that she lost 4.54kg since her last exam. Assess and interpret Ms. Wilcox's weight. (0.2 x 3 = 0.6) 3. Calculate the patient's energy and protein needs. Provide the rationale for the standards you used for these calculations. (0.2 x 3 = 0.6) 4. Why was a soft, 4-g Na, high-kcalorie diet ordered? Should there be any other modifications? (0.2 x 3 = 0.6) 5. Select two nutrition problems and complete TWO NUTRITION-SPECIFIC PES statements for this patient (0.2x3x2 = 1.2) 6. Ms. Wilcox asks if she can use a salt substitute at home. What would you tell her? (0.2 x 2 = 0.4) 7. What are some practical ways in which this patient can deal with thirst seeing that she has a fluid restriction (0.2 x 3 = 0.6).