Case Study: Liver Disease​ What Could It Mean? What signs

Case Study: Liver Disease​ What Could It Mean? What signs or symptoms of liver disease does Annette present with? Annette (preferred pronouns: she, her) is a 35-year-old elementary school teacher. She is overweight with a history of diabetes, hypertension, and peptic ulcer disease. Because of the stress of teaching, she often unwinds at night with 3-4 glasses of wine a day. For her arthritis, she takes an herbal medicine she bought online, based upon manufacturer reviews. ​ Annette went to her nurse practitioner because Annette noted that her belly was expanding, fatigue, and edema in her legs and ankles. Her clothes and shoes were no longer fitting. She has had a fever for 3 days. Upon further testing, her liver function tests were elevated. Markers for viral hepatitis were negative. She did not have any known exposures to infectious diseases. ​ The radiologist noted some ascites fluid during the radiology exam. The radiologist did not see abnormalities of the gall bladder although it was noted that Annette had an enlarged spleen. ​ The nurse practitioner took a careful medication history and was concerned regarding the herbal medicine Annette bought online and unlabeled ingredients on the bottle.

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