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?!
+12019-06-11T20:23:03Z
catch-22The principle is you can get liver dysfunction without having HSM, ascites, etc. Liver disease is on a progressive spectrum.+32019-06-15T22:45:56Z
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.+2019-06-20T01:12:37Z
charcot_bouchardFor Ascities u need to have portal HTN. Thats a must. (unless exudative cause like Malignancy)+12019-08-12T06:57:19Z
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".+2019-12-22T04:15:48Z
to snoo-finity ... and beyond!
submitted by sajaqua1(258), 2019-06-10T13:47:00Z
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.