Chief Complaint: 49-year-old man with abdominalpain, fever and yellowing of the skin and whites of the eyes.
History: Vincent Miller, a 49-year-oldaccountant, has had a \"drinking problem\" throughout most of hisadult life. He has been hospitalized on several occasions over theyears. He reports dull pain in the right, upper quadrant of theabdomen, intermittent fever of 3 weeks duration, and a yellowing ofthe skin and the whites of the eyes. A diagnosis of\"alcohol-induced hepatitis (liver inflammation)\" is listed in thechart. With excessive intake of alcohol, the liver switches overfrom the use of fats and carbohydrates as its primary \"fuel\" to theuse of alcohol as its primary fuel. This can lead to excessiveproduction of lactic acid, which, in turn, can cause inflammationof the liver tissue.
Answer the questions below.
1. Is the diagnosis consistent with the location of theabdominal pain? Explain your answer. How does this differ fromcircumstances of referred pain and what is the anatomical basis ofvisceral referred pain?
2. What is the physical relationshipbetween the liver, gallbladder and duodenum? Be sure to includeother organs that may share anatomical features.
3. If Vincent's liver disorderresulted in the production of a \"gallstone,\" what danger might thatpresent for his pancreas? Be specific.
4. Propose a possible treatment forthe patient in this case study. How does this treatment improveconditions for the patient? Are these improvements seen at thecellular, tissue, organ or systemic level?
