The (months and often even years). Normally,

Theconcerns I have for Mr.

E is that he may have liver cirrhosis that is alcohol-related based on the amount of alcohol he ingests on a daily basis. Cirrhosisof the liver occurs when the liver is slowly deteriorating and is unable toperform its functions due to a chronic injury that occurs over a long period oftime (months and often even years). Normally, the liver can regenerate cellswhen damaged. However, if the injury is long lasting, the cells cannot regenerate.This leads to the liver creating scar tissue called fibrosis which can lead tocirrhosis if scar tissue begins to build up and take over most of the liver. Ifthis happens, healthy liver tissue is replaced with scar tissue and the liverbegins to fail due to the scar tissue inability to perform the job of normalhealthy liver cells.Patients with liver cirrhosis often have appearances that are very subtlesuch as finger clubbing to the more obvious such as jaundice.

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1Mr. E has one of the more noticeable symptoms, jaundice, the yellowish appearanceof his skin. Jaundice occurs when the liver can no longer eliminate bilirubin,a by product formed when hemoglobin from old red blood cells are broken down.Normally, the liver metabolize and excrete bilirubin.

However, since bilirubincannot be metabolized and excreted, it is build up in the blood and oftendeposited its yellow pigment into the skin.To add, Mr.E large abdomen is also due to a non functional liver. Oneof the liver’s tasks is to filter blood.

However, since the liver is notfunctioning, new veins called portosystemic collateral veins are formed.2Veins in the abdomen serve as a potential collateral channel to the systemiccirculation. These veins are common in portal hypertension due to cirrhosis.2 Portal hypertension develops when there isa increase in pressure due to blood not being able to flow in the liverproperly leading to a swollen abdomen.

2Furthermore, spidernevi also appear frequently in alcohol related cirrhosis.3Rosacea and rhiophyma skin conditions are common as well but are often overlook.3 Mr. E has both spider nevi andrhiophyma. Additionally, Mr.

E shows signs of aging.  In recent studies, aging has been associatedwith liver injury.41 O’Shea, Robert S. , Dasarathy,Srinivasan , McCullough, Arthur J. , “Alcoholic Liver Disease”. Hepatology 51, no.

1 (2010): 307-312.2Sharma, Malay., Rameshbabu, Chittapuram S.

, “Collateral Pathways in PortalHypertension”. J Clin Exp Hepatol 2,no.4 (2012): 338-339.3Koulaouzidis, A.

, Bhat, S., Moschos, J., “Skin manifestations of liver diseases”.Annals of Hepatology 6, no.3 ( 2007):181.

4Kim, Hee , Kisseleva, Tatiana, Brenner, David A., “Aging and liver disease”. Curr Opin Gastroenterol 31, no.3 ( 2015)184.

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