Gastroenterology
Case 18: A Heavy Drinker with Jaundice
CASE
A 45‐year‐old man is admitted with jaundice. He admits to being a very heavy drinker, consuming a bottle of spirits a day. His only previous admission to hospital was following a road traffic accident a number of years ago. He has had a number of visits to A&E for minor injuries and falls. He is unemployed having lost his job as a labourer due to drink‐related problems. He is separated from his wife and two young children. He takes no regular prescription medications.
On examination he is drowsy and smells ketotic. He has a fever of 38.5°C. He is quite deeply jaundiced and has palmar erythema and scattered spider naevi. Abdominal examination reveals marked hepatomegaly and some flank percussion dullness consistent with ascites.
Blood tests showed:
Hb 10.8 g/dL MCV 110 fL WCC 15.2 × 109/L Platelets 98 × 109/L PT 20 sec Na 122 mmol/L K 3.2 mmol/L Urea 1.7 mmol/L Creatinine 98 µmol/L Albumin 22 g/L Bilirubin 328 µmol/L ALP 340 U/L AST 450 U/L
QUESTION 1
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Why do patients with liver disease develop spider naevi and palmar erythema?