1. Step 4
1.1. Hypothesis organization (tentative solution)
1.1.1. alcoholic liver disease
1.1.1.1. fatty liver disease
1.1.1.2. alcoholic hepatitis
1.1.1.3. cirrhosis
1.1.1.4. HCC
1.1.2. viral hepatitis
1.1.3. medication induced liver injury
1.1.3.1. acetaminophen
1.1.4. herbal ingestion
1.1.4.1. عرق السوس
1.2. 20 minutes
2. Step 1
2.1. Identify terms and cues
2.2. New terms
2.2.1. cognac
2.2.2. downturn
2.2.2.1. going bad
2.3. cues
2.3.1. 52 yo male
2.3.2. feeling tired and unwell for 2 weeks
2.3.3. yelloish eyes
2.3.4. intermittent hot and cold
2.3.5. long lasting interst in wine and whiskey consistent for 15 yrs
2.3.5.1. 1 before dinner and 3 with dinner and 2-3 whiskey after dinner (standard size glasses)
2.3.6. recent increase in wine intake for the last 6 weeks
2.3.6.1. because of anxiety
2.3.6.2. 10-12 standard drinks per day
2.3.7. upper abdominal discomfort in the right side
2.3.8. loss of appetite
2.3.9. worrying about liver disease
2.4. 10 minutes
3. Step 5
3.1. Formulate learning objectives
3.1.1. alcoholic liver disease
3.1.1.1. classification
3.1.1.2. pathophysiology
3.1.1.3. manifestation
3.1.1.3.1. hot and colds ??
3.1.1.4. diagnosis
3.1.1.4.1. lab
3.1.1.4.2. imaging
3.1.1.4.3. PE
3.2. 10 minutes
4. Step 2
4.1. Problem formulation (put it in a senates)
4.1.1. 52 yrs old male, who is chronic alcoholic, presented to the GP complaining of yellowish eyes, right upper abdominal discomfort, tiredness for 2 weeks, intermittent hot and cold, and loss of appetite. his alcohol intake has increased over the last 6 weeks
4.2. 10 minutes
5. Step 3
5.1. Hypothesis generation (brainstorming)
5.1.1. tiredness
5.1.1.1. liver injury leads to decrease energy production
5.1.1.2. impairment in the absorption
5.1.1.3. accumulation of toxic materials in the liver
5.1.2. yellowish eyes
5.1.2.1. accumulation of billirubin in the blood
5.1.2.1.1. pre hepatic
5.1.2.1.2. hepatic
5.1.2.1.3. post hepatic
5.1.3. right upper abdominal discomfort
5.1.3.1. mostly hepatic cause
5.1.3.1.1. visceral stretching of the liver
5.1.4. feeling hot and cold
5.1.4.1. inflammation
5.1.4.1.1. because of cytokines release by the liver
5.1.4.2. infection
5.1.4.2.1. malaria
5.1.4.3. vasodialation affect of alcohol
5.1.5. loss of appetite
5.1.5.1. can leads to anorexia
5.1.5.2. increased level of billirubin
5.1.6. increase alcohol
5.1.6.1. can affect the liver
5.1.6.1.1. chronic hepatitis
5.1.6.1.2. fatty liver disease
5.1.6.1.3. cirrhosis
5.1.6.2. anxiety
5.1.6.3. safe intake is 2-3 for men and 1-2 for women
5.1.6.3.1. testosterone inhibitors