Case history
Case history #1
A 50-year-old man presents to his general practitioner with complaints of fatigue for 2 months. He also notes distension of his abdomen and shortness of breath beginning 2 weeks ago. His wife reports that the patient has been having episodes of confusion lately. The patient has a significant medical history of chronic heavy alcohol consumption of about half a pint of vodka daily for around 20 years. On physical exam the patient is noted to have scleral icterus, tremors of both hands, and spider angiomata on the chest. There is abdominal distension with presence of shifting dullness, fluid waves, and splenomegaly. Laboratory examination shows low haemoglobin, low platelets, low sodium, aspartate aminotransferase (AST) elevation > alanine aminotransferase (ALT) elevation, and high prothrombin time (PT) and international normalised ratio (INR). Ultrasound of the abdomen shows liver hyperechogenicity, portal hypertension, splenomegaly, and ascites.
Case history #2
A 38-year-old man presents to the emergency department for severe alcohol use with nausea and vomiting. He has a significant medical history of chronic heavy alcohol consumption of about one bottle of wine each day for about 5 years until 1 year ago; since then he has had severe intermittent binge alcohol intake. He reports no other significant medical problems. The patient is confused and slightly obtunded, and hepatomegaly is discovered on physical exam. His body mass index is 22. Pertinent positive laboratory values show low haemoglobin, AST elevation > ALT elevation, normal PT and INR, and very high serum alcohol level. Ultrasound of the abdomen shows fatty infiltration in the liver.
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