Hannah James76 said:Here are all the lab results I have: L 4.59, E 3.94, Hbg 128, Hct 0.35, MCV 88.8, MCH 32.54, MCHC 366, T 82, PV 0.79, INR 1.18, AST 266, ALT 201, CK 61, LDH 158, Glucose 6.2, Urea 19.3, Creatinine 261, total/direct bilirubin 52.1/20.1, serum amylase 81, Na 133, K 4.4, Cl 102, CRP 10.
Diagnoses: Hepatocellular carcinoma, Chronic Hepatitis B, Ascites, Grade II esophageal and gastric varices, Portal hypertensive gastropathy, Cholecystolithiasis, Malnutrition.
Status: Conscious, oriented, mobile, eupneic, afebrile, normal peripheral perfusion. Head and neck externally unremarkable. Lungs clear upon auscultation. Heart rhythm is regular, sounds are clear, BP 110/80 mmHg. Abdomen: distended above the chest level, ascites present, non-tender, liver and spleen are not palpable, bowel sounds are audible. Extremities without edema, arterial pulses normal.
A paracentesis was performed, evacuating 3.5 liters of clear ascites.
His urine output is low, he isn't having bowel movements, and he’s barely eating anything at all.
Instead of using a selective beta-blocker like Carvedilol, he could be put on Propranolol at a dose of 80mg twice daily (for the portal hypertension and those dilated veins in his esophagus). Given the diagnoses listed above, we should also consider adding anemia and Stage III/V chronic renal failure to the list. We could increase the Aldactone dose to about 200mg. His electrolytes are... well, they're okay, I guess. But despite all that, what he
needs most right now is Palliative Care.P.S. In case you don't know what these diagnoses mean: Hepatocellular carcinoma—liver cancer.
Chronic Hepatitis B—long-term Hep B infection.
Ascites—fluid buildup in the abdomen.
Grade II esophageal and gastric varices—swollen veins in the esophagus and stomach, stage 2.
Portal hypertensive gastropathy—gastropathy caused by portal hypertension (increased pressure in the portal vein), which is what causes the ascites and the swelling of the veins in the stomach and esophagus. He has a low platelet count, likely due to a Vitamin K deficiency.
Cholecystolithiasis—gallstones.
Malnutrition—undernourishment.
Stage III/V chronic renal failure—kidney failure, stage 3.
His urine output is weak because of the ascites.
If anything else is unclear, feel free to ask.