Question 2- explain the admitting diagnosis risk factors and etiology and weather this patient is within that risk factor profile.
What are the risk factors for Cirrhosis? Cirrhosis is a chronic liver damage from a variety of causes leading to scarring and liver failure. It is a condition in which scar tissue gradually replaces healthy liver cells and can eventually stop the liver from doing its job.
More common causes of cirrhosis:
One cause of cirrhosis is chronic alcohol abuse. Chronic alcoholism is the first most common cause of cirrhosis in the United States. Most alcohol is broken down by the liver by an enzyme in the liver cells called ADH. However, If the amount of alcohol exceeds the liver breaking down capacity, the liver cells can eventually become damaged. People who drink heavily are much more likely to develop cirrhosis, compared to those who drink less. The amount of alcohol it takes to damage the liver varies from person to person, each individual system is different. Research has said that women who drink two or fewer drinks a day and men who drink three or fewer drinks a day may not cause liver injury because it is within the limit. It is drinking more than the recommended amount that leads to fat and inflammation in the liver, which in the long run leads to alcoholic cirrhosis.
S.G. is a 46 year old white male I would say is within the risk profile factor of cirrhosis. S.G. was a chronic alcohol drinker who stopped drinking 4 years ago. He was also diagnosed with alcoholic cirrhosis. He previously drank 3 cases of beer/week for 15 years. Because alcohol contributes to cirrhosis, it was the likely cause of the disease in this patient. The continuous use of alcohol over a long period of time, usually about 10 years causes the disease.
Another cause of cirrhosis is chronic viral hepatitis ( Hepatitis B&C Infection). Chronic hepatitis C is the second leading cause of cirrhosis in the United States. Hepatitis C is a blood-borne infection that can damage the liver and cause it to swell, eventually leading to cirrhosis. Hepatitis C virus spreads through contact with infected blood, such as sharing needles, injecting drugs, or receiving blood through blood transfusion. Also, Hepatitis C can be spread through sexual contact with an infected person or at time of childbirth, from mother to newborn. Hepatitis B also causes cirrhosis but it’s not as common or widespread as Hepatitis C and it’s most common in other parts of the world, such as in Africa and Asia.
S.G. test result shows that he has been infected with Hepatitis C at some point in the past. His Anti-HCV Test is positive for the virus. Another possible explanation for this test result could be related to the patient status post, he might have acquired the disease when he went for a blood transfusion 30 years ago, when he had an appendectomy. Getting blood transfusion could also lead to getting the Hepatitis C virus.
Accumulation of fat in the liver area (nonalcoholic fatty liver disease/ nonalcoholic steatohepatitis (NASH)) also leads to cirrhosis. NASH is the third leading cause of cirrhosis in the United States. The accumulation of fat in the liver causes the liver to scar, swell, and become inflamed, eventually leading to cirrhosis. NASH is most likely to occur in people who are obese, have diabetes, people with high blood pressure, high cholesterol, and people who have metabolic syndrome – a group of traits and medical conditions linked to being overweight and obese that makes people more likely to develop both cardiovascular disease and type 2 diabetes.
S.G. is overweight based on result of his vital signs, his height, weight and BMI. He is a 5’7” male who weights 171 lbs with a BMI of 26.8. Because S.G. is overweight and he keeps gaining weight. His gaining weight might be contributing to his cirrhosis. He has unintentionally gained 15 lbs during the past four weeks as mentioned by his wife.
Less common causes of cirrhosis are:
A condition know as Hemochromatosis is a condition in which there is an excessive amount of iron in the body, and because there is too much iron in the body, it accumulates overtime and causes cirrhosis. Another condition is Wilson’s disease, this is a condition whereby there is too much coper formation in the body, with too much buildup, it can lead to cirrhosis if not treated. In autoimmune Hepatitis, the persons own immune system attacks healthy organs in the body as though they were foreign substances. Here, the liver is attacked. The immune system job is to fight infection in the human body by identifying and destroying bacteria, viruses, and other harmful substances. In autoimmune hepatitis, the body’s immune system attacks liver cell and causes inflammation, damage, and eventually cirrhosis.
Hemochromatosis, wilson’s disease, and autoimmune hepatitis are genetic diseases. S.G. did not inherit cirrhosis from his parents, but from the use of too much alcohol from his past. Hemochromatosis and wilson’s disease can be ruled out as a contributing factor to S.G. condition because all his lab values for iron and copper are within normal limits. S.G. does not have autoimmune hepatitis because his cirrhosis is due to alcoholism from the past.
Destruction of the bile ducts (primary biliary cirrhosis). Several diseases can damage, destroy, or block the ducts that carry bile from the liver to the small intestine, causing bile to back up in the liver and lead to cirrhosis. The most common in adult is primary biliary cirrhosis (a chronic disease that causes the small bile ducts in the liver to become inflamed and damaged). Also, another is called primary sclerosing cholangitis – this is a disease that causes irritation, scarring, and narrowing of the larger bile ducts of the liver. Cystic fibrosis and Gallstones are two conditions that can also lead to bile duct damage. S.G. does not have a history of gallstones or cystic fibrosis which could have cause destruction of his bile duct and led to cirrhosis.