Cullen Hughes November 29th, 2017
NUTR 222- Case Study 2
Wade Moore, a 51-year-old male software engineer, is brought to the emergency room by his wife after he suffered what appeared to be a seizure. She tells the emergency room doctor that he has been acting different recently, stating that he often becomes confused and forgetful, and even began coughing up blood approximately two weeks ago. Wade appears to have a yellow tint to his skin and he is complaining of stomach pain and swelling as well. He has a history of intravenous drug use but he has been sober for 22 years. He can count the number of times he has consumed alcohol on one hand; he says he does not like the way it affects people.
Wade Moore’s Lab Results:
Weight: 275 Height: 5’9 Blood Pressure: 135/79
Liver Enzymes: Elevated Fasting Glucose: 356mg/dL
1. Wade Moore’s case is troubling to his physician because he seems to be presenting with very severe symptoms of a disease that may have been manageable if it had been diagnosed earlier. (A) What chronic disease is Wade currently suffering from?
Wade is suffering from cirrhosis as a result of chronic liver disease.
(B) List the names of the three symptoms that Wade is experiencing that helped you come to this conclusion and what their effects are.
The three symptoms that helped me come to this conclusion were jaundice (which causes yellow skin), hemoptysis (which is why Wade coughed up blood), and Hepatic Encephalopathy (which causes Wade to be confused and forgetful).
(C) Based on Wade’s social history, this disease may have been caused by an infection. What do you believe may have been the cause of the infection and what is it called?
I believe the cause of Wade’s receiving the infection was him possibly using dirty needles when he participated in intravenous drug use. The infection that led to him having chronic liver disease is hepatitis, most likely Hepatitis C since it is transferred through blood-to-blood contact. The reason that it took so long for Wade’s disease to progress to this state is because liver disease is very slow-moving, often taking upwards of a decade for full symptoms to show.
(D) What pathological condition may be the cause of Wade coughing up blood?
Hemoptysis may be the cause of Wade coughing up blood, as hemoptysis is often a side effect of various liver conditions.
2. A secondary concern for Wade is that his fasting glucose is elevated as well. (A) What is the most probable cause of his elevated blood glucose?
The most probable cause of Wade’s elevated blood glucose is his cirrhosis. Cirrhosis puts pressure on portal veins and makes it difficult for blood to flow, which leads to high blood pressure.
(B) What are three of Wade’s risk factors that make him more likely to develop this disease?
The three risk factors that made Wade more likely to develop this disease were his untreated chronic hepatitis, his chronic Hepatitis C, and his drug-induced liver injury.
(C) Wade has a very sedentary job and does not move around much. His doctor notices that he has sores on his feet, but they do not seem to be causing him any discomfort. Why do you believe he doesn’t feel the painful sores?
Wade doesn’t feel the painful sores in his feet due to peripheral neuropathy, which occurs due to chronic liver disease and leads to numbness in the extremities.
(D) What are 3 dietary recommendations in order to help improve the condition listed above in “A”?
Three dietary recommendations to improve Wade’s cirrhosis are to eat high kcalorie foods (as long as these are not empty calories but rather are nutrient-dense), consume .8 – 1.2 g of protein per kilogram of body weight every day, and consume complex carbs as opposed to simple sugars, as simple sugars will elevate glucose levels to even higher levels than Wade is already experiencing.
3. If Wade’s condition does not improve, he may ultimately need a very drastic procedure requiring the use of immunosuppressive drugs. (A) What procedure is this?
This procedure is liver transplantation, as immunosuppressive drugs are used for liver transplants in order to give the body the greatest chance to accept the new liver. If the immune system is highly active following the procedure, there is a reduced chance of the new organ being accepted.
(B) What are two main concerns regarding this surgical procedure?
Two main concerns regarding liver transplants are organ rejection and infection following the operation. Immunosuppressive drugs are prescribed in order to (hopefully) prevent both of these from occurring.
(C) If this procedure is not effective, what are three vital roles that will be affected as a result?
If this procedure is not effective, three vital roles that will be affected as a result are the body’s ability to clot blood, the body’s ability to conduct metabolic processes such as digestion, and the body’s ability to break down fats and produce energy.