Case Study 10
Mr. Smith is a 36-year-old male, unemployed for past 6 months. He has smoked
one pack of cigarettes per day for 16 years. His father was an alcoholic. He drinks
a 12-pack of beer/day, but has not had any for 2 days. He has had several
admissions for detoxification and has graduated from a rehabilitation program.
Presenting S/S:
Vomiting bright red blood, dizziness, passing black tarry stools for two days.
Relevant Lab values:
Hgb 10.3; HCT 28%; WBC 12,400; platelets 120,000; blood alcohol level 152; Na
136; K 3.4;
CO2 26; Cl 105; Mg 1.0; BUN 7; CR 0.7
Liver function tests:
SGOT 234; Protein 4.9; SGPT 84; Albumin 2.7; LDH 310; Alk phos 114; CPK 369;
Total bilirubin
5.0; PT 12.8 sec; Conjugated Bilirubin 3.4; Unconjugated Bilirubin 1.6
Relevant diagnostic tests:
Upper endoscopy - normal duodenum, erosive & portal hypertensive gastropathy &
varices in the distal esophagus.
In your review of this case, please address the following questions. Please include at
least 5 research articles and /or Web citations as references.
1. What are the etiology and risk factors associated with this case?
2. What is the pathophysiological basis for the signs/symptoms that are presented in
this case?
Question #2:
2.) What is the pathophysiological basis for the signs/symptoms that are presented in this
case?
Mr. Smith’s history of chronic alcohol abuse and smoking caused scarring or damages to his liver cells.
the scar tissue blocks the flow of blood through the liver and slows its processing functions. Alcohol
abuse is also known to cause bone marrow suppression, myopathy Alcoholic myopathy). Bone marrow
suppression affects platelets and red blood cell production resulting to anemia and thrombocytopenia
seen in this case study. Increased pressure in the portal vein causes large veins (varices) to develop
across the esophagus and stomach to get around the blockage. The varices become fragile and can
bleed easily. They are an important cause of blood loss, which may be slow and insidious causing
anemia, or sudden and severe, causing massive and occasionally fatal hemorrhage. Obstruction of the
Mr. Smith is a 36-year-old male, unemployed for past 6 months. He has smoked
one pack of cigarettes per day for 16 years. His father was an alcoholic. He drinks
a 12-pack of beer/day, but has not had any for 2 days. He has had several
admissions for detoxification and has graduated from a rehabilitation program.
Presenting S/S:
Vomiting bright red blood, dizziness, passing black tarry stools for two days.
Relevant Lab values:
Hgb 10.3; HCT 28%; WBC 12,400; platelets 120,000; blood alcohol level 152; Na
136; K 3.4;
CO2 26; Cl 105; Mg 1.0; BUN 7; CR 0.7
Liver function tests:
SGOT 234; Protein 4.9; SGPT 84; Albumin 2.7; LDH 310; Alk phos 114; CPK 369;
Total bilirubin
5.0; PT 12.8 sec; Conjugated Bilirubin 3.4; Unconjugated Bilirubin 1.6
Relevant diagnostic tests:
Upper endoscopy - normal duodenum, erosive & portal hypertensive gastropathy &
varices in the distal esophagus.
In your review of this case, please address the following questions. Please include at
least 5 research articles and /or Web citations as references.
1. What are the etiology and risk factors associated with this case?
2. What is the pathophysiological basis for the signs/symptoms that are presented in
this case?
Question #2:
2.) What is the pathophysiological basis for the signs/symptoms that are presented in this
case?
Mr. Smith’s history of chronic alcohol abuse and smoking caused scarring or damages to his liver cells.
the scar tissue blocks the flow of blood through the liver and slows its processing functions. Alcohol
abuse is also known to cause bone marrow suppression, myopathy Alcoholic myopathy). Bone marrow
suppression affects platelets and red blood cell production resulting to anemia and thrombocytopenia
seen in this case study. Increased pressure in the portal vein causes large veins (varices) to develop
across the esophagus and stomach to get around the blockage. The varices become fragile and can
bleed easily. They are an important cause of blood loss, which may be slow and insidious causing
anemia, or sudden and severe, causing massive and occasionally fatal hemorrhage. Obstruction of the
