1. Step 4
1.1. Hypothesis organization (tentative solution)
1.1.1. chronic liver disease
1.1.1.1. hepatitis
1.1.1.2. malignancy
1.1.1.3. hepatotoxicity
1.1.1.3.1. medication
1.1.1.3.2. alcohol abuse
1.1.1.4. autoimmune
1.1.2. biliary tract disease
1.1.2.1. obstruction
1.2. 20 minutes
2. Step 1
2.1. Identify terms and cues
2.2. New terms
2.3. cues
2.3.1. 48 yo
2.3.1.1. GB
2.3.2. migrated from korea to Australia
2.3.3. drinks alcohol exceesssivly coping with frustration
2.3.3.1. progressivly increased
2.3.4. over last 3 mo, noticed drop in energy
2.3.5. fullness in abdomen and swollen ankles
2.3.6. his eyes became jaundice with dark urine
2.3.6.1. 3 weeks
2.4. 10 minutes
3. Step 5
3.1. Formulate learning objectives
3.1.1. to understand the pathophysiology of alcoholic liver disease
3.1.1.1. presentation
3.1.1.2. systemic effects of alcohol consumption
3.1.1.3. diagnosis
3.1.1.4. DDx
3.1.2. to understand the pathophysiology of chronic liver failure
3.1.2.1. etiology
3.1.2.2. presentation
3.1.2.3. diagnosis
3.1.3. To understand the pathophysiology of jaundice
3.2. 10 minutes
4. Step 2
4.1. Problem formulation (put it in a senates)
4.1.1. 48 yo male excessive alcohol drinker complaining of low energy -for the last 3 months-, abdominal fullness, jaundice eyes, swollen ankles, and dark urine -last 3 weeks-.
4.2. 10 minutes
5. Step 3
5.1. Hypothesis generation (brainstorming)
5.1.1. low energy
5.1.1.1. prodromal symptoms?
5.1.1.2. hemolytic anemia through blood cells debri
5.1.2. jaundice eyes
5.1.2.1. bilirubin increase due to liver abnormality
5.1.2.1.1. should not escape to blood stream
5.1.3. abdominal fullness
5.1.3.1. alcohol abuse
5.1.3.2. decrease albumin in blood > oncotic pressure decrease > fluid shifting
5.1.3.3. hydrostatic pressure increase
5.1.3.4. hepatomegaly manifestation?
5.1.4. swollen ankles
5.1.4.1. albumin absorption reduction
5.1.5. dark urine
5.1.5.1. conjugated bilirubin excretion