34 year old male with Cirrhosis secondary to alcohol with portal hypertension with gross ascites

CBBLE  UDHC SIMILAR CASE STUDY

C/O YELLOWISH DISCOLORATION  of eyes and urine since7-8 days
c/o abdominal distension since 7days

Hopi-pt was apparently asymptomatic 7 months back,then the first time he had yellowish discoloration of eyes he was admitted to a local hospital and was diagnosed with alcoholic liver disease and was advised to stop alcohol.

2 months back his brother expired,out of agony he again started drinking excess alcohol 180-360 ml since 40 days.

patient developed progressive distension of abdomen associated with yellowish discoloration of eyes and urine.

h/o fever on and off since 1 week

h/o constipation since 2 days

no h/o melena,hematemesis,no sleep disturbances

Past h/o-not a k/c/o DM,HTN,BA,CVD

Treatment h/o-no known drug allergies

Family h/o-no significant family history

Personal history-pt moderatly built and moderately nourished

bowel -constipation since 2 days

addictions-alcohol-whisky 180-360 ml daily

General examination-pt c/c/c

ictreus-present,pedal edema-present

no pallor/cyanosis/lymphadenopathy

vitals-
bp-80/50 mmhg
pr-80 bpm
rr-16 cpm
spo2-98@ RA

Systemic examination-

cvs-s1,s2 heard

rs-bae+,nvbs heard

p/a-distended,non tender,free fluid-present,bowel sounds-present

cns-nad

Investigations-
USG
ECG

Diagnosis-Cirrhosis secondary to alcohol with portal hypertension with gross ascites

Treatment-
1.inj thiamine 1 amp in 100 ml ns iv/bd
2.inj pan 40 mg iv/od
3.in zofer 4 mg iv/od
4.tab lasix 20 mg po/bd
5.tab aldactone 50 mg po /od
6.bp/pr/temp monitoring 4th hourly


26/2 
Icu bed no :2 
S: distension of abdomen,decreased urine output

O: o/e pt c/c/c 
 No pallor , icterus (+) , no cyanosis , no clubbing , no lymphadenopathy, edema (+)
Temp : AFEBRILE 
PR : 98 bpm 
Bp : 110/80 @ noradrenaline10 ml/hr 
Grbs : 78mg/dl 
Spo2 : 99% @ room air 
CVS : S1S2 + 
Rs : BAE+ 
P/A: Distended,nontender
CNS : NAD 
Urineoptout: last 14 hrs 30ml high coloured urine 
A : Cirrhosis  Secondary to alcohol with portal hypertension with hepatorenal type-2 with gross ascites 
P: Inj .Thiamine 1 amp in 100 ml ns / IV/BD 
     Inj . PAN 40 mg / IV / BD 
     Inj . Zofer 4 mg / IV / tid 
     Tab . Aldactone 50 mg / po/BD 
     Inj NORAD -DS to maintain bp > 65mmhg 
     Syp . Lactulose 10ml/po/BD 
      Soap water enema
      Inj . VIT K 10mg / slow IV /OD 
      Inj. Magnexforte 1.5 GM / IV /0D 
      Proctoclysis enema - twice daily
       Inj . Lasix 20 mg IV /OD



Popular posts from this blog

39 yr old male with acute pancreatitis?

Image
C/O-PAIN ABDOMEN SINCE 45 days, EPIGASTRIC,DRAGGING TYPE OF PAIN HOPI-PT WAS APPARENTLY ASYMPTOMATIC 45 DAYS AGO THEN HE DEVELOPED PAIN ABDOMEN(EPIGASTRIC REGION) ASSOCIATED WITH NAUSEA AND LOSS OF APETITE NO VOMITINGS NO COMPLAINTS OF CONSTIPATION/OBSTIPATION NO JAUNDICE PAST HISTORY-N/K/C/O DM,HTN,BA,EPILEPSY NO H/O SIMILAR COMPLAINTS IN THE PAST FAMILY H/O -NO SIGNIFICANT FAMILY HISTORY   PERSONAL H/O- PT IS MODERATELY BUILT AND MODERATELY NOURISHED BOWEL AND BLADDER MOVEMENTS REGULAR H/O ALCOHOL INTAKE-REGULAR,TODDY SINCE 15  YEARS,WHISKY 250 ML ONCE IN 2 DAYS  FOR 1 YEAR. No OTHER ADDICTIONS GENERAL EXAMINATION- PT C/C/C NO PALLOR/ICTREUS CYANOSIS/EDEMA/LYMPHADENOPATHY VITALS- TEMP-AFEBRILE BP-110/80 PR-90 RR-20 SPO2-98% AT RA SYSTEMIC EXAMINATION- CVS-S1,S2  HEARD,NO MURMURS RS-BAE PRESENT,NVBS HEARD P/A-SOFT,NONTENDER,BS+ CNS-NAD DIAGNOSIS- ACUTE PANCREATITIS? TREATMENT- 1.IVF NS/RL/DNS -100 ML/HR 2.INJ PAN 40 MG IV/OD 3.INJ ZOFER 4MG/IV/SOS 4.INJ TRAMADOL 1 AMP/IV/SOS IN 10
Read more

45 YEAR OLD FEMALE CASE OF VIRAL PYREXIA WITH THROMBOCYTOPENIA

Image
C/O  fever since 3 days Dark coloured stools since 2 days HOPI: Patient was apparently normal 3 days back then she developed high grade fever a/w chills Dark coloured stools present No Burning micturition No pain abdomen No neck stiffness Past History -  Not a k/c/o HTN , DM,TB, Asthma , CAD, CVD  Personal history - Diet - mixed Appetite - Normal  Bowel & bladder movements - regular  No addictions Family history - not significant On Examination  patient is c/c/c No pallor , icterus , cyanosis , clubbing lymphadenopathy , edema Vitals - Temp - Afebrile PR - 80bpm BP - 110/80 mmHg RR -16 cpm SpO2- 98%@RA Systemic examination - CVS - S1 S2 +VE  RS -BAE +VE , NVBS +VE  P/A - soft , non tender , BS +ve  CNS - NAD  Provisional diagnosis -  Viral pyrexia  with Thrombocytopenia TREATMENT: 1.IVF 2 UNITS NS @100ml/hr 2.Tab pan 40mg OD 3.Tab PCM 650Mg TID 4.INJ Optineuron 1amp on 100ml NS OD 4.Monitor vitals and inform sos
Read more