MEDizzy - A 56-year-old alcoholic man presents to the emergency

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Liver Gallbladder and Pancreas

A 56-year-old alcoholic man presents to the emergency department with confusion and lethargy. On physical examination, he is visibly jaundiced with ascites. Laboratory studies reveal increased prothrombin time and prolonged activated partial thromboplastin time, as well as significantly increased serum ammonia levels. Given a significantly increased serum ammonia, which of the following physical findings might you expect to see?

ExplanationAsterixis is a flapping tremor of the hands associated with hepatic encephalopathy. Failure of the liver to detoxify metabolites absorbed from the gastrointestinal tract leads to accumulation of nitrogenous wastes that are neurotoxic. Caput medusae results from dilation of the periumbilical venous collaterals as a result of portal hypertension and activation of portal-caval anastomoses. Capillary telangiectasias, and gynecomastia result from the hyperestrinism seen in liver disease with failure of the liver to metabolize estrogen.