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3 years ago

The case begins with a 23 year old woman who presents to her

The case begins with a 23 year old woman who presents to her

Physical exam on

Physical exam on admission was significant for the presence of jaundice and scleral icterus, as well as mild abdominal distention indicative of ascites. She had no other stigmata of chronic liver disease. Typical findings: icterus, hepatomegaly, splenomegaly, spider angiomata, palmar erythema, excoriations Advanced disease: muscle wasting, ascites, edema, dilated abdominal veins, hepatic fetor, asterixis, confusion, stupor, coma 37.8, 112/62, 72, 17, 100% RA 4

Admission labs revealed persistently elevated transaminases, as well as some evidence of synthetic dysfunction with low serum levels of albumin and cholesterol, and a persistently elevated INR. She had a normal platelet count and her acetaminophen level was less than ten. 5

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Mr. P is a 76 year old male with cardiomyopathy and congestive heart failure who has been hospitalized frequently to treat CHF symptoms. He has difficulty maintaining diet restrictions and managing his polypharmacy.
Mr. P is a 76 year old male with cardiomyopathy and congestive heart failure who has been hospitalized frequently to treat CHF symptoms. He has difficulty maintaining diet restrictions and managing his polypharmacy.
Mr. P is a 76 year old male with cardiomyopathy and congestive heart failure who has been hospitalized frequently to treat CHF symptoms. He has difficulty maintaining diet restrictions and managing his polypharmacy.
Mr. P is a 76 year old male with cardiomyopathy and congestive heart failure who has been hospitalized frequently to treat CHF symptoms. He has difficulty maintaining diet restrictions and managing his polypharmacy.