A 52-Year-Old Man with Jaundice

Introduction. A 52-year-old man presented to urgent care at the behest of his family for evaluation of recent onset of “yellow eyes,” which was noted about a week prior to his visit.

Patient history. Along with his “yellow eyes,” which appear to be darkening, according to his family, the patient also noted upper abdominal pain. The patient’s family noted his mental slowness and tendency to obtundation requiring frequent arousal.

The patient had previously been reasonably healthy—he has no major medical diagnoses, nor any prescriptions for chronic or new ailments. He has been a successful salesman with frequent traveling related to his job. Although he denies it, his family believes “he drinks too much.” They noted that he has ample opportunity for drinking between his job and frequent traveling. In the last 18 months, he has missed some of his quarterly sales quotas, which has led to increased stress, resulting in more noticeable drinking at home to “relax.” In the last 3 years, he has had two violations for driving while intoxicated.

Physical examination. The patient’s physical examination reveals a somewhat somnolent man with obvious jaundice. His vital signs are normal except for an oral temperature of 100.4°F. His head, eyes, ears, nose, and throat examination reveals jaundice, as expected. The examination also found several spider telangiectasias on his chest and shoulders. There is moderate tenderness in the epigastrium and right upper quadrant. There is definite firm, tender hepatomegaly and shifting dullness was appreciated. There was +1 pitting edema of the feet and ankles.

The patient’s neurological examination revealed a mild degree of obtundation mentioned by his family with frequent verbal prodding required to obtain his concentration and answering of questions. There was asterixis of the wrists as well.

Laboratory Findings. The patient underwent a battery of blood testing. (Table 1)