Alcoholic Liver Disease 2

Question

Vignette: A 45-year-old woman with a history of heavy alcohol use presents to her physician with complaints of persistent fatigue, weight loss, and abdominal discomfort. She also reports that she has been experiencing nausea and vomiting for the past few weeks. On physical examination, her abdomen is tender to palpation and she has hepatomegaly. Lab tests reveal elevated serum levels of aspartate aminotransferase (AST), alanine aminotransferase (ALT), and gamma-glutamyl transferase (GGT). Her serum albumin level is decreased and her prothrombin time is prolonged. Which of the following is the most likely diagnosis?

Choices

A. Acute hepatitis

B. Alcoholic cirrhosis

C. Hepatic adenoma

D. Non-alcoholic fatty liver disease

E. Hepatocellular carcinoma

Answer

B. Alcoholic cirrhosis

Explanation

This patient's history of heavy alcohol use, clinical presentation, and lab findings are consistent with alcoholic cirrhosis. Chronic alcohol consumption leads to hepatocellular damage, which manifests as elevated serum transaminase levels (AST and ALT). The elevation of GGT is a sensitive marker for alcohol abuse. Prolonged alcohol use can lead to fibrosis and the formation of regenerative nodules, characteristic of cirrhosis. Cirrhosis, in turn, can lead to decreased hepatic synthetic function, which is reflected in this patient's low serum albumin level and prolonged prothrombin time. This is because the liver is responsible for the synthesis of most plasma proteins, including albumin and clotting factors. Hepatomegaly is also a common finding in alcoholic liver disease. The patient's symptoms of fatigue, weight loss, abdominal discomfort, nausea, and vomiting are nonspecific but can be seen in chronic liver disease.