Case Study: Liver Disease and Hepatitis B

Case Study: Liver Disease and Hepatitis B Case study   Ã¢â‚¬â€œ Liver Disease Introduction A 60 year old woman with a history of hepatitis B and cirrhosis presents with oedema and constipation. The GP takes the following tests on her and these are the results. Albumin 30g/L Platelet count Alpha – fetoprotein 450 ng/mL Test results The test results can be used for analysis to clarify what disease the 60 year old woman has, and by linking her symptoms with the test results. Hepatitis B is a virus that affects the liver, chronic hepatitis can develop without proper treatment. Having hepatitis B will eventually cause scarring to the liver which is known as cirrhosis. The 60 year old woman has developed Chronic hepatitis, the hepatitis is ongoing and serious, this will eventually cause the liver tissue to produce scares and stop functioning as it should .A liver biopsy (tissue sample) can be taken to find out how serious the hepatitis is. One of the function of the liver is to produce a protein called albumin, having liver cirrhosis will cause permanent damage to the liver and when this happens the liver will find it had to produce albumin.(Aspinall et al 2011:Pubmed) Albumin is a protein that is made by the liver which measures the exact amount of protein in the clear liquid portion in blood. The test is usually t aken place to determine whether a person has a sort of liver or kidney disease which is the main reason why the test was carried out. The normal range in human is between 3.4 – 5.4g/dL. The woman’s albumin level shows that it is below average, low albumin may cause oedema which is a symptom that the woman is experiencing. Cirrhosis results in an increase in fluid retention. Cirrhosis also leads to low levels of albumin and other proteins in the blood which could also be the cause of oedema. (Gupta and Lis, 2010) Platelet count determines the amount of platelet in the blood, normal adults produce 1 x10^11 platelets every day, portal hypertension is a complication of cirrhosis of the liver. Portal hypertension always takes place in the liver at all times, an increase in the pressure within the portal vein is caused by barrier of the blood flow to through the liver (Kotoh et al 2012). Portal hypertension causes symptoms to patients that are linked to their liver disease which could be hepatitis B,C or cirrhosis, patients that have cirrhosis had a very high chance of developing portal hypertension and it was increase over years. Patients who have portal hypertension usually have low platelet count which is the case of the 60 year old woman whose platelet count is Alpha fetoprotein is a protein that is found in the liver, it is considered a tumour marker for liver cancer, the test may be done to diagnose possible liver diseases. The normal values in males or non-pregnant females is generally less than 40 micrograms/litre.High levels of alpha-fetoprotein indicates that there could be liver cancer which is the key factor which shows that there is something wrong with the liver.If your AFP level is unusually high but you are not pregnant, it may indicate the presence of certaincancers or liverconditions.so a liver transplant could be an option for the woman. In adults, high blood levels can be a sign of certain types of cancer, including liver cancer. (Alejandro et al, 2012) Symptoms and Diagnosis Constipation is a liver related issue, in this case It was most likely caused by her progressing tumour formation this may press on her digestive system causing constipation, having cirrhosis may also not allow her to properly digest fatty lipids because her bile might possibly be blocked resulting in constipation.  Hypothyroidism  can cause constipation. Blood tests to check thyroid hormones / TSH will help in diagnosing hypothyroidism. Oedema is swelling that is caused by fluid trapped in the bodies tissues, oedema can be a sign of lots of things including malnourishment and low albumin level in the blood and the woman’s albumin level is below average these are the results of having liver failure and cirrhosis. Having history of cirrhosis is the main reason she has oedema. (Gaw et al 2013) Because of the woman’s age cancer would need to be tested for cancer as old people are much more prone to have cancer. Albumin is produced by the liver meaning that her liver is affected inducting liver cancer. Some patients with chronic liver diseases are more likely to develop thyroiditis, hyperthyroidism or hypothyroidism through autoimmune mechanisms (Huang, Liaw 2008). The woman may have Hepatocellular Carcinoma (HCC) which is most common and popular type of liver cancer. The main risk factors associated with HCC are hepatitis B,C and cirrhosis which the woman has a history of. HCC develops in patients with chronic liver disease and patients with cirrhosis are more likely to develop HCC and people over the age of 50 are more likely to develop HCC. The most common diseases that affects the liver are cirrhosis and hepatitis (Marshall and Bangert 2008). HCC is a serious disease in which alpha-fetoprotein will be elevated in a person, alpha-fetoprotein is a gene that becomes expressed when lots of damage has occurred to the liver in HCC. The normal range for AFP is 10-20 ng/mL.A level of >400 ng/mL may be regarded as diagnostic for HCC by some. Further tests A test that can be proposed is an ultrasound of the liver, an ultrasound test uses sound waves to create pictures and to see what is going on with organs inside the body. If any tumours are found in the liver then this can be furthered to test for cancer. An MRI scan can be useful for looking at liver cancers, MRI are sometimes good at telling which cancers are a tumour. Another tests that can be carried out is biopsy which involves actually taking the tumour and inspecting it under the microscope for further analysis which is likely to be more effective and reliable. Alanine aminotransferase(ALT)An alanine aminotransferase (ALT) test measures the amount of this  enzyme  in the blood. ALT is found mainly in the  liver, ALT is measured to see if the liver is damaged or diseased. Low levels of ALT are normally found in the blood. But when the liver is damaged or diseased, it releases ALT into the bloodstream, which makes ALT levels go up. Most increases in ALT levels are caused b y liver damage. Treatment and Prognosis Some treatment for HCC can include a liver transplant or surgery which can remove small or small-growing tumours.Sorafenib tosylate (Nexavar), which is an oral medication can be taken to block and stops tumour from growing.The prognosis is often poor, because only 10 20% of hepatocellular carcinomas can be removed completely using surgery. Radio frequency ablation can be used to kill cancerous cells. If the cancer cannot successfully be removed or killed, the disease is usually deadly within 3 6 months. However, this is not always the case as everybody is difference and so on some occasions people will survive much longer than 6 months. (Forner at al 2012: Pubmed) References Alejandro Forner, Josep M Llovet, Dr Jordi Bruix. (2012). The Lancet.  Hepatology. 379 (9822), P1245–1255. Allan Gaw, Michael J. Murphy, Rajeev Srivastava, Robert A. Cowan, Denis St. J. OReilly. (2013).  Clinical Biochemistry. 5th ed. London: Churchill Livingstone. p197-202. Aspinall EJ, Hawkins G, Fraser A, Hutchinson SJ, Goldberg D.. (2011). Pubmed:  Occupational Medicine. 8 (2), p531-540. Digant Gupta and Christopher G Lis. (2010). Nutrition Journal. Pubmed:  Pretreatment serum albumin as a predictor of cancer survival: A systematic review of the epidemiological literature. 9 (69), p112-120. Feldman M, Friedman LS, Brandt LJ, Pratt DS (2010).  Liver chemistry and function tests. 9th ed. Philadelphia: Saunders Elsevie. p436-450. Kazuhiro Kotoh, Marie Fukushima, Yuki Horikawa, Shinsaku Yamashita, Motoyuki Kohjima, Makoto Nakamuta, Munechika EnjojiJanuary. (2012). Experimental and theurapitcal mediine.  Serum albumin is present at higher levels in alcoholic liver cirrhosis as compared to HCV-related cirrhosis. 3 (1), p166-170. Miau-Ju Huang and Yun-Fan Liaw. (2008). Wiley Online Library.  Journal of Gastroenterology and Hepatology. 10 (3), P237–364. William J Marshall, Stephen K Bangert (2008).  Clinical chemistry. 6th ed. Edinburgh: Mosby Elsevier. p40-50.

JoAnn Marshall - The Roles of Southern Women, Black and White, in Society :: Essays Papers

JoAnn Marshall - The Roles of Southern Women, Black and White, in Society Lillian Smith provides a description of the typical black woman and the typical white woman "of the pre-1960's American South" (Gladney 1) in her autobiographical critique of southern culture, Killers of the Dream. The typical black woman in the South is a cook, housekeeper, nursemaid, or all three wrapped up in one for at least one white family. Therefore, she is the double matriarch of the South, raising her own family and the families of her white employers: "It was not a rare sight in my generation to see a black woman with a dark baby at one breast and a white one at the other, rocking them both in her wide lap" (Smith 130). The southern black woman's duties extend far beyond rearing children, as she also serves as a family counselor, confidant, and nurse for the entire white family (Smith 129) and her own if time permits. She can do all this and more because she is strong, wise, and insightful in all areas of life (Smith 119). In short, the southern black woman is the cornersto ne of the southern, domestic life. The white woman in the South has an equally important role. The southern white woman is responsible for maintaining southern social order, better known as Southern Tradition. She establishes "the 'do' and the 'don't' of behavior" (Smith 132) in her children and believes, "If you could just keep from them all the things that must never be mentioned, all would be well!" (Smith 142). At the same time, the southern white woman sits atop the pedestal of Sacred Womanhood that her husband and his ancestors built for her (Smith 141). She meekly sits there, a symbol of southern society used to benefit men's ideals, feeling empty and powerless against everything going on around her (Smith 141-2). The whispers in her children's ears and her presence on that pedestal fulfill the white woman's role as protectress of Southern Tradition, but does not fulfill the southern white woman. In fact, the roles of the southern black woman and the southern white woman are equally important and equally oppressive: "In a culture where marriage and motherhood were women's primary roles, neither black nor white women were free to be fully wives or mothers, and neither were able to sh ield their children from the physical and psychic destruction of the racist society in which they lived" (Gladney 6).

The Development and Sustainability of Group Cohesion

It is important to realize that in all aspects of life, especially the workplace, a person needs to encompass the dualities of professionalism and emotionalism in order to be a successful leader and promote group cohesiveness. Due to the relative traditionalism associated with the application of professionalism, this essay will deal mostly with the recent addition of emotionalism as an important factor in determining the type of leadership style necessary in developing group cohesiveness. Emotions are an essential and unavoidable element of organizational life. Despite the fact that members in organizations experience emotions in many different forms, researchers have often failed to study the effects of emotion in the workplace. This new development in organizational behavior suggests that these types of considerations should be discussed and investigated further when evaluating different approaches to the development of group cohesiveness. Developing a strategy for the development of group cohesiveness is dependent upon many different factors. Group dynamics are influenced by distinctiveness from the organization as a whole, and also in the composition and development of the particular group structure involved. Once isolated, this group structure may present other barriers to the development of effective group cohesiveness such as intra- and inter-group conflicts that arise from the particular merit system established within the group. For example, if group members are â€Å"not evaluated on a per/team basis,† members may develop unhealthy competitiveness within the individual group itself (Briggins 81). One inherent paradox within most group structures is the need for trust to exist before trust can develop. This adds difficulty to establishing group cohesiveness within any group, no matter the form. An example of a loss in group cohesiveness from external group conflicts may arise when there is a lack of distinction between the evaluation of each particular group, with the result of tension being established. Tensions are often fuelled by affective or expressive concerns that have little to do with instrumental or task-focused concerns, and minor disagreements can therefore, quickly escalate into major conflicts with group members polarized into different rival camps. Due to the many potential problems of group dynamics, the considerations involved in developing group cohesiveness take on a different appearance than traditional management decision-making processes. Some of the key considerations one must investigate when discussing the phenomenon of group cohesiveness deal exclusively with the recognition of the different aspects of emotionalism. Many times researchers assume that emotionality and rationality are antithetical, and thus, in the rationally based world of modern management, CEO†s ignore emotional concerns when establishing group standards and leadership. Due to this type of belief, when evaluating group cohesiveness, no normalization or recommendation has generally been given to group leaders in the evaluation of and interaction with the emotions of the group members (Carr 48). In actuality, emotionality and rationality have been found to be interpenetrated and interdependent, because emotions, as well as rational thought (one would hope), are involved in every group decision making process. The concept of â€Å"cohesiveness† itself is defined as â€Å"the attractiveness of a group to its members, highlighting the affective bond between individuals†(Pettit 13). Thus in order for management to develop a consistent policy for the development of group cohesiveness, emotionality must be considered as well as the aforementioned possible difficulties which may arise out of the different forms of groups and the group dynamics associated with each form. There are many possible costs and benefits involved in the development and support of group cohesiveness within any organization. One important consideration that may lead to both benefits and downfalls in the development of group cohesiveness is emotional contagion. Emotional contagion is the tendency for a member of a group to mimic another group member†s emotional experience/expression and thus to experience/express the same emotions his or herself. Emotional contagion underlies such phrases as â€Å"team spirit† and â€Å"electricity in the air†, and it is the same reason why teammates tend to cheer and clap during sporting events in order to â€Å"root teammates on† (Frisch 16). Emotional contagion can be a very constructive or destructive force in organizations. On the positive side, contagion may increase empathy and solidarity, creating a cohesive group. This contagion can be mobilized in the pursuit of organizational goals. It has even been supposed that the interaction and sharing of emotions promote group cohesiveness to the extent that they develop a kind of â€Å"group mind†. On the negative side, though, contagion can also impair performance. It may cause negative emotions such as fear and anxiety to quickly pervade the entire group, and in turn the entire organization. This often results in infighting and factionalism. There are many factors essential to the CEO in the development and sustainability of group cohesiveness. One must evaluate the different dynamical group constructs in order to prevent intra- and inter-group conflicts. It is also essential for any leader of any organization to recognize the emergence of emotionalism as a major factor in the evaluation and implementation of any plan for group cohesiveness. The final and perhaps most important consideration the CEO must undertake, is the evaluation of the impact of emotional contagion and what means may be implemented to help develop effectively transformational leadership processes for the groups in the organization. All of these considerations should help the CEO to establish and sustain group cohesiveness within the entire organization.

Personal Leadership Style Of My Career Essay - 896 Words

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