Pathophysiology and Pharmacology

Case Study
With the signs and symptoms presented by Mrs. Green, it can be concluded that she has liver failure. The liver failure can be attributed to cirrhosis or hepatitis. Cirrhosis is also known as the scarring of the liver (Alexander, Fawcett & Runciman 2006). It is an irreversible liver condition that is primarily caused by alcohol or viruses (Allen 2002). On the other hand, hepatitis is the enlargement of the liver, again caused by alcohol or viruses. Cirrhosis is however, the more severe of the two.
Signs and Symptoms
Certain signs and symptoms displayed by the patient, and which are attributed to liver failure, are discussed in the following:
a) Fatigue and Malaise Associated with Alcohol Abuse
Scarring of the liver, which eventually leads to the destruction of liver cells, can be attributed to prolonged low-grade inflammation (Alexander, Fawcett & Runciman 2006). As stated earlier, alcohol or viruses can cause liver inflammation. As a part of the inflammatory process, individuals may experience the common symptoms of body malaise and fatigue.
The fact that the patient has been experiencing these symptoms for a long period of time suggests that a disease process has been occurring in her body for quite some time. These symptoms can be associated to the patient`s drinking habit. The patient`s alcohol consumption may have caused the damage to the liver thus, aggravating the patient`s experiences of fatigue and malaise.
b) Bilateral Edema and Abdominal Tenderness
The patient has presented with bilateral edema and also abdominal tenderness. The abdominal tenderness was hypothesized to have been caused by her constipation or the accumulation of ascites. It is postulated that as the cirrhosis process continues, "the remaining liver cells proliferate to form nodules; this results in the liver becoming irregular and distorted in shape. The resistance to the flow of blood increases, which in turn leads to portal hypertension" (Alexander, Fawcett & Runciman 2006, p. 138). On the other hand, portal hypertension activates necessary vasodilatory mechanisms in order to compensate for the change in the liver`s physiology. These vasodilatory mechanisms results to the dilation of the peripheral and splanchnic arterioles, which in turn causes a drop in arterial pressure (Kashani et al. 2008). The drop in arterial pressure activates the renin-angiotensin-aldosterone system (RAAS), the sympathetic nervous system (SNS) and the release of antidiuretic hormone in order to effect homeostasis. However, as these systems are activated in the body, there becomes an increase in sodium and water retention in the kidneys. As a result, edema develops. Furthermore, "splanchnic vasodilation increases splanchnic lymph production exceeding the lymph transportation system capacity and leads to lymph leakage into the peritoneal cavity" (Kashani et al. 2008, p. 72). As a result, ascites formation occurs. Both edematous and ascites formation tendencies have been observed in the patient indicative of cirrhosis.
c) Multiple Bruises to Legs
The final sign observed from the patient was that of multiple bruises. The bruises can be attributed to low platelets and clotting factor deficiencies of the patient (Bowden & Greenberg 2009). Kang and Audu (2006) stated that liver disease affects all the five phases of coagulation. These are: "the vascular phase, the platelet phase, the fibrin formation phase, the fibrin polymerization phase, and the fibrinolysis phase" (Kang & Audu 2006, p.17). If taken in a more general context, these five phases can be attributed to vasodilation, decreased platelet and clotting factor deficiencies. Vasodilation has the effect of decreasing vessel wall and platelet interaction (Kang & Audu 2006). Thus, platelets travel to injured sites more slowly, prolonging bleeding time. The decreased number of platelets may also be due to folic acid deficiency in alcoholic liver disease, platelet consumption, sequestration of platelets in the regenerating liver and splenomegaly (Kang & Audu 2006). In the case of clotting factors, the liver is responsible for producing most of the proteins that are involved in coagulation (Kang & Audu 2006). Thus, due to the ongoing degradation of the liver that is associated with cirrhosis, platelets are destroyed at a higher rate by the liver. Moreover, there is a decreased production of coagulation factors. Both scenarios lead to easy bruising of a patient and also the possibility of uncontrolled bleeding.
The first set of signs and symptoms suggests that, within the patient, a disease process is ongoing. The second set of signs and symptoms suggest that the disease process or pain is felt at the abdomen. With the patient`s background of alcohol use and the relatively large size of the liver, it can be hypothesized that the liver is the specific site of pain. Finally, multiple bruises can be indicative of platelet or coagulation factor deficiencies. With the inculcation of the other signs and symptoms, coagulation deficiencies can thus be associated with the liver again. This is because the liver destroys platelets, and produces coagulation factors. The liver is very much involved in coagulation processes. Therefore, the probability that the patient has liver failure is high. With the association of alcohol, cirrhosis comes to mind.
Hepatic Encephalopathy
Ascites formation can also be attributed to hepatic encephalopathy. Moreover, as the disease process progressed, the patient presented with other signs and symptoms that are attributable to hepatic encephalopathy. Aside from ascites formation, the low levels of glucose and high levels of ammonia from the blood tests indicate the possibility of hepatic encephalopathy.
"Hepatic encephalopathy (HE) is a brain disorder caused by chronic liver failure, particularly in alcoholics with cirrhosis, which results in cognitive, psychiatric, and motor impairments" (Butterworth 2004). The liver is responsible for glucose metabolism. Certain studies have shown that people with alcoholic cirrhosis have a "decreased glucose uptake in the region of the brain involved in controlling the "attention system" responsible for monitoring, for example, visual stimuli as well as in selecting appropriate responses to these stimuli" (Butterworth 2004).
On the other ...