The Good Life

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The Good Life by Mind Map: The Good Life

1. Step (6): Review of Learning Objectives

1.1. 1- To list the main differential diagnosis for jaundice

1.1.1. prehepatic hemolysis gilbert syndrome crigler najjar uncongugated

1.1.2. intrahepatic congugated and uncongugated primary billiary cirrhosis viral toxic

1.1.3. posthepatic congugated obstructive jaundice cancer pancreas

1.1.4. charcot triade

1.2. 2- To identify alcoholic liver diseases, and how to differentiate from other liver diseases

1.2.1. definition toxic effect of alcohol on hepatocytes

1.2.2. diseases alcoholic fatty liver usually asymptomatic steatohepatitis symptomatic cirrhosis portal hypertension hematemesis edema SOB

1.2.3. pathophisiology it is an effect of liver metabolism acetaldehyde hepatitis elevation of NADH intestinal flora lipopoly sacharides

1.3. 3- How to approach an alcoholic patient

1.3.1. how much he drinks for how long?

1.3.2. physical exam

1.4. 4-To identify causes of liver cirrhosis

1.4.1. common chronic viral hepatitis alcoholic liver diseases non alcoholic fatty liver

1.4.2. less common wilson alpha 1 antitrypsin deficiency portal fibrosis

2. Third Session

2.1. 2nd trigger

2.1.1. 1-18months after first time

2.1.2. 2-hematemesis

2.1.3. 3-confused

2.1.4. 4-increasingly forgettful

2.1.5. 5-mixing things over the last 3months

2.1.6. 6-increasing abdominal destention

2.2. Step (10): Management

2.2.1. Goal prevent or slow progression abstenence of alcohol prevent having a superimposed liver insult vaccinations managing associated symptoms nutritional managment clostramine or anti histamine plasmapheresis anemia stress management and support withdrwal symptoms managing the case prognosis liver transplant 6 months of alcoholic abstinence decompensated

2.2.2. hepatitis start with steroid 2wks pentxifylline 4wk liver transplant

2.2.3. patient managment bleeding endoscopic stabilization beta blocker shunting hepatic encephalopathy rifaximin

2.3. Step (11): Feedback & Resources

3. Second Session

3.1. Step (7): Gathering Information & Inquiry Plan

3.1.1. History CAGE RUQ pain first time alcohol difficulty focusing ywo weeks yellowish eye never had black stool never vomited blood married 2 children all in good health his wife has interest in wine, not more than 2 glasses no rectal bleeding past history no surgeries HBV,HCV NO no medication non smoker no drugs decreased libido 5yrs ago antique business downturn of economic status

3.1.2. Physical Examination vital signs general appearance not distressed BMI=22 tired STIGMATA of liver diseases hand head neck chest abdomen neurological mild muscle weakness no tremor no sensory impairment no cerebellar dysfunction cardiovascular normal respiratory normal GI liver no other abdominal mases spleen

3.1.3. Investigation Blood test Hgb=109 WBC= MCV=103 PLATALETE =90 BIOCHEMISTRY na=134 k=1.2 creatinen cl LFT liver enzymes COAGULATION ALBUMIN BILLIRUBIN SEROLOGY -VE US liver =15cm CT macronodular parynchymal pattern consistent with cirrhosis

3.2. Step (8): Diagnostic Decision

3.2.1. Mechanism toxic effect of chronic alcohol drinking on the liver cell, impairing its function

3.2.2. Presentation jaundice RUQ pain

3.2.3. Supporting Data

4. First Session

4.1. Step (1): Identifying Difficult Words & Cues

4.1.1. Difficult Words cognac french brand of alcohol single malt whiskey downturn

4.1.2. Cues male 52yo feeling unwell and tired for the last two weeks eyes turned yellow hot and cold RUQ discomfort loss of appetite long standing interest in alcohol 15 years increased in last 6 weeks whiskey , wine, and cognac increased anxiety due to business downturn

4.2. Step (2): Problem Formulation

4.2.1. a 52 yo male,persistent alcohol drinker, presenting with yellow eyes, fatigue, and RUQ discomfort for the last 2 weeks.

4.3. Step (3): Hypotheses Generation

4.3.1. liver pathology alcohol jaundice the pathology fatty liver alcohol metabolized in the liver

4.3.2. downturn business anxiety increased drinking

4.3.3. jaundice prehepatic blood hemolysis genetic hepatic toxic infections genetic posthepatic biliary duct stone pancreatic cancer

4.3.4. loss of appetite may indicate liver problem

4.3.5. alcohol risk 60g/day is the cut point our patient is having 105g/day for 15yrs

4.3.6. hot and cold

4.4. Step (4): Hypotheses Organization

4.4.1. prehepatic

4.4.2. hepatic

4.4.3. posthepatic

4.5. Step (5): Learning Objectives

4.5.1. 1- To list the main differential diagnosis for jaundice

4.5.2. 2- To identify alcoholic liver diseases, and how to differentiate from other liver diseases definition pathophysiology work-up

4.5.3. 3- How to approach an alcoholic patient

4.5.4. 4-To identify causes of liver cirrhosis