A 65-year-old male presents to emergency department with 5 hours of change in mental status after pr

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A 65-year-old male presents to emergency department with 5 hours of change in mental status after protein intake. The patient is confused, cannot answer questions with precision, and demonstrates inappropriate behavior and emotion. He has suffered “cirrhosis” for 10 years.His spleen has been resected. Physical examination demonstrates a somnolent but arousable man, who is oriented only to name.He is jaundiced. Small. spider like tangles of blood vesscls are present over the neck and chest. The protuberant abdomen has shifting dullness. Large wavy blood vessels are noted in the periumbilical area. On voluntary hand dorsiflexion,a flapping motion is noted.Laboratory testing revealed the following: urine protein (-), urobilinogen (++), urobilirubin(+) ;ALT 96 IU /L, AST 72 U/L, total bilirubin 45 umol/L, direct bilirubin 14 umol/L,ammonia 12 umol/L. Ultrasonography revealed a cirrhotic liver with a small quantity of abdominal ascites, Electroencephalography (EEG) revealed delta activity. Questions; 1. What is this patient’s diagnosis? What pathophysiological changes have occurred? 2. What caused the alteration in the patients liver function? 3. What is the main precipitating factors of the patient’s confusion and inappropriate behavior?( 4. What is the cause of the patient’s hyperammonemia? Is hyperammonemia associated with neuropsychiatric manifestations? If so, what is the underlying mechanism? 5. What is the appropriate treatment for this patient?
SCIENCE
HEALTH SCIENCE
NURSING
BIOS 162

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