The patient (not the man in the picture!!) today had alcohol induced cirrhosis -- cirrhosis, its complications, and treatment thereof previously blogged (here, here, and here) with hepatic encephalopathy, massive ascites, and jaundice and possible hepatorenal syndrome.
We also later learned that the patient initially underreported their alcohol consumption. I couldn't find any literature on this in patients with cirrhosis; however, in my experience this is common.
The red-herring in this case was the anorexia and hoarse voice with cough which was supicious for malignancy -- however, we later found out that the patient was also severly hypothyroid which may have explained the hoarse voice -- and the anorexia could be explained by the severe liver disease.
The mental status may have also been depressed due to superimposed myxedema coma and it was important to recognize this.
We also later learned that the patient initially underreported their alcohol consumption. I couldn't find any literature on this in patients with cirrhosis; however, in my experience this is common.
The red-herring in this case was the anorexia and hoarse voice with cough which was supicious for malignancy -- however, we later found out that the patient was also severly hypothyroid which may have explained the hoarse voice -- and the anorexia could be explained by the severe liver disease.
The mental status may have also been depressed due to superimposed myxedema coma and it was important to recognize this.
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