57 year old male case

 

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By G.Saahithya Reddy 

  Roll no -141 

I've been given this case to solve in an attempt to understand patient's clinical data analysis to develop my competency in reading and comprehending including history ,clinical findings , physical examination, laboratory findings and plan of treatment 

Main complaints of the patient are :

• Pedal edema 
• Abdominal distension
• Yellowish discoloration of eyes 
• Bleeding gums 

Analysis :

Pedal edema could be caused by heart disease , renal disease , liver disease , drugs ,infections 

The above complaints mainly point us to a liver disease where we can also see the abdominal distension (ascites ) and yellowish  discoloration of eyes , bleeding gums suggestive of impaired function of liver in producing clotting factors 

1.What is the reason for the patient's ascites ?

Since the patient is chronic alcoholic , ascites could be caused due to alcoholic liver disease 

2.Why did patient develop bipedal lymphedema ? What is the reason for recurrent blebs ,ulcerations and cellulitis in his lower limbs ?

Cellulitis is usually caused due to 

• Weak immune system
• Obesity and overweight
• Infections (HIV and AIDS ,
• Skin injuries 
• Injection drug users
• Corticosteroid drugs
• Alcohol and smoking incraeses the risk 

In my opinion since the patient has lymphedema ,I feel it has incraesed the risk of developing cellulitis ,also alcoholic consumption has increased the risk .

Buildup of fluid in the legs has led to introduction of infective agents which further led to complication namely cellulitis.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2804019/
 

3.What was the reason for asterixis and constructional apraxia and what was done by the treating team to address that?

Asterixis most common cause is "Hepatic Encephalopathy" .Damage to brain cells due to presumably due to inability of liver to metabolize ammonia to urea 

It is a serious complication of " Liver Cirrhosis ". The shunting of blood from portal venous bed to systemic circulation is the key element of hepatic encephalopathyhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC4890879/

Apraxia is seen in patients with chronic hepatic encephalopathy where the patient will have frequent episodes of  episodic encephalopathy or persistent cognitive (memory loss ,confusion and disorientation) or neuromuscular disturbances ( tremors , apraxia ,rarely paraplegia )