Diagnosing and Managing Liver Dysfunction and Endometriosis

Question 2

• From the report and case clue for Maria, it is evident that she is diagnosed with jaundice and This dysfunction is confirmed with blood test (bilirubin and blood creatinine above the normal range) and ultrasound report. Abdominal ultrasound, initial imaging method was used to evaluate the size, texture, and existence of splenomegaly or ascites in the liver. From the scan, it is confirmed that cirrhosis has led to liver dysfunction. Moreover, hepatitis is also positive in blood report, which is another contributor to liver dysfunction.

Cirrhosis is one of the main reasons for liver dysfunction. There are several factors responsible for cirrhosis. The factors varied from fatty liver disease to overdose of alcohol. Another prevalent reason are hepatitis B or C infection, copper deficiency and cholestatic illnesses. Additionally, it has been noted that cirrhosis develops when healthy liver parenchyma is replaced by fibrotic tissue and growing nodules following an extended period of inflammation. (Gines et al., 2021). From the evidence, it is clear that cirrhosis is the main reason behind the liver dysfunction in Marias case.

• Since, Maria is reported to be alcoholic, this could have resulted in severe symptoms of hepatitis, which have led to liver cirrhosis.

A shift toward taurin-conjugates is present in the vast majority of bile acids conjugated in the peripheral plasma of patients with alcoholic cirrhosis (almost 1:1 ratio of glycine- to taurine-conjugates) (Trefflich et al., 2019). Comparable to the bile acid pool, the fraction of CDCA in serum rises as the disease advances toward liver cirrhosis. In cases of severe alcoholic cirrhosis combined with alcoholic hepatitis, this is particularly true. Although the stomach may easily alcohol (ethanol), the small intestine absorbs the majority of it. It is impossible to store alcohol. The majority of the breakdown occurs in the liver, mostly by alcohol dehydrogenase (ADH), cytochrome P-450 2E1 (CYP2E1), and the microsomal enzyme oxidation system (MEOS) (Rambaldi et al., 2008).

Question 3

In the present case, Maria is diagnosed with liver dysfunction, hepatitis and cirrhosis. Since, Marai has complained of being abnormally disoriented and confused, especially in the late afternoon and evening followed by troubled concentrating, this condition is associated with hepatic encephalopathy (HE), a brain dysfunction brought on by portosystemic shunting and/or liver insufficiency. HE is a combination of cirrhosis, which can manifest as a wide range of neurological or psychiatric abnormalities, from subclinical changes to coma. One of the essential measures taken for its management is lactulose therapy (Fu et al., 2022).

Bacterial nitrogen incorporation and bacterial bulk both rise when lactulose is digested by the gut flora. Ammonia and other possible brain poisons are less likely to break down from other nitrogen-containing molecules when there is a carbohydrate present and an acidic environment brought on by the synthesis of organic acids. Giving humans lactulose increases the amount of nitrogen in their feces but has minimal effect on their ammonia. Fecal bacteria and soluble stool fractions hold the majority of the nitrogen in the body. When lactulose is administered, the rate of urea synthesis decreases, which is associated with less ammonia entering the portal circulation(Fu et al., 2022).

Despite not seeming to directly impede urea breakdown, lactulose injection lowers the pace at which urea is produced, which is consistent with a decreased amount of ammonia entering portal circulation. Since lactulose is not linked to toxicity or renal toxicity, it has essentially supplanted neomycin as the standard treatment for portal systemic encephalopathy (Hudson and Schuchmann, 2019). One of the most common risk associated with lactulose therapy is increased rate of gastrointestinal discomfort and frequent diarrhoea.

Question 4

When endometrial tissue is seen outside of the uterus, endometriosis is defined as a chronic, inflammation-related, and estrogen-dependent condition. Injuries affect the rectovaginal septum, ovaries, abdominal cavity, and gastrointestinal system in addition to the pelvic peritoneum (Surrey et al., 2018).

Sensational, painful, and sometimes haemorrhaging bowel motions are frequently caused by endometriosis implanting in the rectal wall. Back discomfort is often caused by lesions located in the perianal area, which is right behind the anus. The rectum, the inside of the intestines, and other areas of the gut can all develop endometrial tissue in intestinal endometriosis (Surrey et al., 2018).

An assortment of symptoms, including altered bowel motions, pain, discomfort, and cramping in the abdomen, are indicative of irritable bowel syndrome, a gastrointestinal illness affecting mainly the large intestine and sharing many clinical characteristics with endometriosis (Saha, 2014).

Because of their shared history of persistent inflammation-induced pelvic pain, irritable bowel syndrome and endometriosis exhibit strikingly similar symptoms. In certain individuals, endometriosis might even seem as IBS (Nabi et al., 2022).

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