A 63-year-old man with a 30-year history of alcohol abuse notes hematemesis for the past day. On examination, he has ascites, mild jaundice, and an enlarged spleen. He also has gynecomastia, spider telangiectasias of the skin, and testicular atrophy. Rectal examination indicates prominent hemorrhoids and a normal-sized prostate. An emergent upper endoscopy shows dilated, bleeding submucosal vessels in the esophagus. Laboratory studies show total protein, 5.9 g/ dL; albumin, 3.2 g/dL; AST, 137 U/L; ALT, 108 U/L; total bilirubin, 5.4 mg/d; prothrombin time, 20 seconds; ammonia, 76 mmol/L; and hematocrit, 21%. Which of the following pathologic findings in his liver is most likely to explain the hematemesis?
Portal fibrosis and nodular hepatocyte regeneration are typical features of chronic alcohol abuse. Spider telangiectasias (angiomas) refer to vascular lesions in the skin characterized by a central, pulsating, dilated arteriole from which small vessels radiate. These lesions result from hyperestrogenism (which also contributes to the testicular atrophy). The failing liver is unable to metabolize estrogens normally. Spider angiomas are a manifestation of hepatic failure. Ascites, splenomegaly, hemorrhoids, and esophageal varices all are related to portal hypertension from cirrhosis and the resultant collateral venous congestion and dilation. The other listed findings do not explain portal hypertension.
Cholangitis
Cholestasis
Cirrhosis
Hepatitis
Liver & Biliary Tract