Gynecomastia, spider angiomata, and hypogonadism (as well as palmar erythema) are all signs of excess estrogen. The liver in patients with hepatic disease is impaired and so cannot clear estrogen sufficiently. Six 12 oz beers daily (72 oz, or half a gallon) is too much, and is destroying his liver.
uslme123No hepatosplenomegaly, ascites, or edema through me off. We that being said, I shied away from cirrhosis. I thought that he showed signed of depression, so I went with the thyroid. But who's to say he isn't injection anabolic steroids?!
+7
catch-22The principle is you can get liver dysfunction without having HSM, ascites, etc. Liver disease is on a progressive spectrum.+14
notadoctorHe likely has hepatitis B/C given his history of intravenous drug use. I believe both can have liver dysfunction but may or may not have ascites, whereas the type of damage we would expect from alcohol that would match this presentation would also show ascites.+
charcot_bouchardFor Ascities u need to have portal HTN. Thats a must. (unless exudative cause like Malignancy)+2
paulkarrFor anyone who needs it; the FA photo is kinda burned into my mind for these questions. NBME has some weird infatuation with this clinical presentation.. FA (2019) Pg: 383 "Cirrhosis and Portal HTN".+5
snripper@paulkarr the problem was that the FA image was burned into my mind so without no ascites or edema threw me off of cirrhosis.+
tyrionwillcirrhosis doesn't present hepatomegaly, instead, the liver could be shrunken.+2
avocadotoastCirrhosis (most likely due to alcoholism in this patient) leads to an increase in sex hormone binding globulin, causing a relative increase in estrogen compared to androgens. Cirrhosis doesn't always have to present with ascites and adema. I agree with @catch-22 that liver disease is a spectrum. This patient does not have ascites because his liver is still able to produce enough albumin to maintain oncotic pressure in the blood.+1
It's an unfortunate case of a depressed patient who is drinking away his problems and progressively damaging is health. He requires serious intervention after saving his liver
submitted by โsajaqua1(607)
Gynecomastia, spider angiomata, and hypogonadism (as well as palmar erythema) are all signs of excess estrogen. The liver in patients with hepatic disease is impaired and so cannot clear estrogen sufficiently. Six 12 oz beers daily (72 oz, or half a gallon) is too much, and is destroying his liver.