RESUMO
Cirrhosis of the liver, characterized by fibrous tissue replacing normal cells, disrupts physiological function and blood circulation. A further consequence of this is hepatic encephalopathy (HE), a neuropsychiatric syndrome that can range in severity from mild cognitive disturbances to full coma. This case follows the course of a 63-year-old Caucasian female with chronic liver cirrhosis who presents with recurrent episodes of mental status changes. Although each episode was treated with first-line pharmacologic interventions of lactulose, her HE recurrence persisted. This case report underscores the significance of early diagnosis and management, emphasizing the role of alcohol cessation, pharmacotherapy, and lifestyle adjustments. It also aims to address the delicate balance of diuretic use, focusing on dosage adjustments to address electrolyte imbalances and minimize risks associated with HE. The findings highlight the complexity of managing alcoholic liver disease and offer insights into tailored approaches for optimizing patient outcomes.
RESUMO
The giraffe juvenile has different proportions of head to neck from the adult. The head just about doubles in size from the juvenile to adult, whereas the neck increases almost 4.5× (roughly four times) in length. The T1 posterior dorsal vertebral width of the newborn is clearly wider than in the adult where it is narrow. In the okapi, the dorsal vertebral width is narrow in both juvenile and adult. The giraffe neck changes in ontogeny anisometrically. In the okapi the changes are more isometric. The giraffe juvenile vertebrae are shorter and do not have fused the cranial epiphyseal plates. That facilitates anterior elongation-growth. The ventral tubercles are undeveloped. The juvenile T1 is wide caudally unlike the adult. This may be a similarity to a gelocid (Gelocidae) ancestor of the giraffe.
