Question: 1. A 55 Year Old Male Visited His Physician Due To Abdominal Swelling And Complained Of Fatigue And Weakness. The Physician Noticed The Patient Had Yellowing Of The Sclera, Splenomegaly And Hepatomegaly. The Patient Admitted To Drinking At Least Five Martinis Every Night And More On The Weekends For A Number Of Years. Review The Tests Below And Answer …

1. A 55 year old male visited his physician due to abdominal swelling and complained of fatigue and weakness. The physician noticed the patient had yellowing of the sclera, splenomegaly and hepatomegaly. The patient admitted to drinking at least five martinis every night and more on the weekends for a number of years. Review the tests below and answer the following questions based on the set of chemistry results: Patient Results 2.5 1.5 Test Total Bilirubin Direct Bilirubin AST ALP ALT Total Protein Albumin GGT Anti-HCV Anti-HAV (IgM) Anti-HAV (total) Anti-HBsAg Anti-HBcAg 350 214 200 7.2 3.0 300 nonreactive nonreactive nonreactive nonreactive nonreactive Normal Range 0.2-1.2 mg/dL. 0.00-0.4 mg/dL 5-40 U/L 30-157 U/L 5-40 U/L 6.0-8.4 g/dL 3.5-5.0 g/dL. 2-30 U/L nonreactive nonreactive nonreactive nonreactive nonreactive a. Describe the pathological changes that are occurring in the liver in this condition. (2 pts) b. List four causes that may be contributing to these lab results. (2 pts) c. Given the results and history of this patient, state the most probable cause of his condition. (1 pt) d. If the physician is suspecting hepatic coma, what test should be ordered? (1 pt) e. Calculate the indirect bilirubin result. (1 pt)