Case Study Peggy Fender

Peggy Fender is a 59 year old woman who appears to be an alcoholic as she has had many visits to the emergency department in the past. She arrives in the afternoon appearing intoxicated and complaining of abdominal pain in the right upper quadrant of her abdominopelvic cavity. As Tim, the physician assistant proceeds with his examination he notices bruising on her arms legs and face. She is jaundiced and he notices the smell of alcohol on her breath. In addition, her liver and entire abdomen are swollen. Her blood tests reveal elevated blood transaminases, high blood glucose, and prolonged prothrombin time. Based on her history and present findings he diagnoses her with alcoholic cirrhosis. Tim suspects alcohol abuse based on many of his exam findings. Three of those signs could have been as follows. 1) Ascites is the accumulation of fluid in the peritoneal cavity. In alcoholic cirrhosis, the portal vein becomes scarred and blocked, causing an excessive increase in hydrostatic pressure. This leads to an increase in capillary hydrostatic pressure. Alcoholic cirrhosis also causes the liver to underproduce albumin proteins. This lowers osmotic pressure in the vasculature, enhancing filtration out of the capillaries. The cumulative effect is fluid leaking and accumulating …show more content…
Fender’s jaundice is caused by the accumulation of bilirubin in her blood and tissues. Bilirubin is a byproduct of worn out erythrocytes. Hemoglobin from worn-out erythrocytes is broken down into heme and iron. The iron is recycled, and the heme is further degraded into bilirubin, bound to albumin, and carried to the liver. The liver removes it from the blood and excretes it into the intestines as bile. When the liver is damaged (as in cirrhosis or hepatitis), bilirubin, which is yellow, finds its way into the bloodstream. Blood of course is sent all over the body, including tissue thereby giving the skin a yellowish appearance. Jaundice is also noticeable in the eyes of