A 17yr old male or with history of seizures


Case History and Clinical Findings
C/O DISTENSION &FULLNESS OF ABDOMEN SINCE 2 MONTHS
C/O YELLOWISH DISCOLORATION OF EYE SINCE 2 MONTHS
HOPI:PT WAS APPARENTLY ASYMPTOMATIC 2 MONTHS BACK THEN HE DEVELOPED
FULLNESS OF ABDOMEN ,INSIDIOUS IN ONSET .A/W DISTENSION OF ABDOMEN INSIDIOUS
ONSET ,GRADUALLY PROGRESSIVE .A/W SHORTNESS OF BREATH ,AGGRAVATING ON
TAKING FOOD &IN SITTING POSITION
A/W LOWER BACK PAIN
H/O YELLOWISH DISCOLORATION OF EYE
H/O EPIGASTRIC PAIN SINCE 2 MONTHS,BELCHING +
NO H/O CONSTIPATION,FEVER,BULKY STOOLS
NO H/O LOOSE STOOLS,VOMITINGD,PRURITUS
NO H/O MALENA,HEMATEMESIS,HEMATURIA
NO H/O PEDAL EDEMA,FACIAL PUFFINESS
NO H.\/O ORTHOPNEA,PLATYPNEA,FROTHY URINE
PAST ILLINESS:
NO SIMILAR COMPLAINTS IN THE PAST

K/C/O CVA LEFT SIDED UL &LL,MOUTH DEVIATION 4 YEARS BACK
H/O SEIZURES 4 YEARS BACK ,UPROLLING OF EYES +,STEARING LOOK
N/AK/C/O HTN,DM,TB,THYROID DISORDERS,COPD,ASTHMA
ON EXAMINATION:
PT IS C/C/C
PR:78BPM
BP:110/60MMHG
RR:17CPM
WEIGHT:42KG
CVS:S1,S2+.NO MURMURS
RS:BLAE+,CLEAR
LOCAL EXASMINATION:GIT
ON INSPECTION:ABDOMEN IS DISTENDED,ELLIPTICAL IN SHAPE
UMBILICUS-SHAPE INVERTED
POSITION-CENTRAL
DISCHARGE-NO
MOVES WITH RESPIRATION
NO ENGORGED VEINS,VISIBLE PULSATIONS,HERNIAL ORIFICES
ON PALPATION:
FLUID THRILL-ABSENT
LIVER -PALPABLE
SPLEEN-NOT PALPABLE
ABDOMEN GIRTH-36INCHES
ON PERCUSSION:
SHIFTING DULLNESS +
ON AUSCULTATION:
BOWEL SOUNDS PRESENT
CNS:
HMT +
 RT LT
TONE UL N INCREASED
 LL N INCREASED
POWER UL 5/5 4/5
 LL 5/5 4/5

REFLEXES B 2+ 2+
 T 2+ 2+
 S 2+ 2+
 K 2+ 3+
 A 2+ 4+
 P F E
Investigation
Name Value Range
Name Value RangeBLOOD UREA 21-03-2024 01:00:PM 16 mg/dl 42-12 mg/dl
SERUM CREATININE 21-03-2024 01:00:PM 0.5 mg/dl 1.3-0.9 mg/dlSERUM ELECTROLYTES (Na,
K, C l) 21-03-2024 01:00:PMSODIUM 137 mmol/L 145-136 mmol/LPOTASSIUM 4.2 mmol/L 5.1-3.5
mmol/LCHLORIDE 99 mmol/L 98-107 mmol/L
LIVER FUNCTION TEST (LFT) 21-03-2024 01:00:PMTotal Bilurubin 9.20 mg/dl 1-0 mg/dlDirect
Bilurubin 7.18 mg/dl 0.2-0.0 mg/dlSGOT(AST) 777 IU/L 35-0 IU/LSGPT(ALT) 422 IU/L 45-0
IU/LALKALINE PHOSPHATASE 829 IU/L 369-54 IU/LTOTAL PROTEINS 6.4 gm/dl 8-6
gm/dlALBUMIN 2.6 gm/dl 4.5-3.2 gm/dlA/G RATIO 0.68COMPLETE URINE EXAMINATION (CUE)
21-03-2024 01:00:PMCOLOUR ReddishAPPEARANCE ClearREACTION AcidicSP.GRAVITY
1.010ALBUMIN TraceSUGAR NilBILE SALTS NilBILE PIGMENTS NilPUS CELLS NilEPITHELIAL
CELLS 0-1RED BLOOD CELLS NilCRYSTALS NilCASTS NilAMORPHOUS DEPOSITS
AbsentOTHERS Nil
HBsAg-RAPID 21-03-2024 01:01:PM NegativeAnti HCV Antibodies - RAPID 21-03-2024 01:01:PM
Non ReactivE
USG WAS DONE ON 22/03/24
IMPRESSION:CHRONIC LIVER DISEASE(CLD)
MILD SPLEENOMEGALY
MODERATE ASCITES(POST DRAINAGE)
COLLATERALS IN MESENTRY
F/S/O CLD WITH PORTAL HYPERTENSION
NORMAL CALIBRE &DIRECTION OF FLOW IN PORTAL VEIN
Diagnosis
HYPERCOAGULABLE STATE SECONDARY TO PROTEI- S DEFICIENCY
? CAD SECONDARY TO ? HEPATIC VEIN CLOT
S/P DECOMPRESSIVE CRANIOTOMY SECONDARY TO CARDIOEMBOLIC STROKE WITH LV
CLOT
Treatment Given(Enter only Generic Name)
T.LASILACTONE (50/20) PO/BD(1-0-1)
T.ECOSPIRIN-AV (75/10)PO/HS(0-0-1)
T.CARDIVAS 3.125MG PO/OD(1-0-0)
INJ ZOFER 4MG IV/SOS
T.LEVIPIL 250MG PO/BD(1-0-1)
T.UDILIV 300 MG PO/BD(1-0-1)
Advice at Discharge
REFER TO HIGHER CENTRE:
PT ATTENDERS HEVE EXPLAINED ABOUT THE CONDITION THAT IS HYPERCOAGULABLE
STATE SECONDARY TO PROTEIN S DEFICIENCY .CHRONIC LIVER DISEASE WITH PORTAL
HYPERTENSION.S/P DECOMPRESSIVE CRANITOMY SECONDARY TO CARDIOEMBOLIC
STROKE WITH LV CLOT.COMPLICATIONS ASSOCIATED WITH LIKE VARICEAL
BLEEDING,HYPOTENSION,ENCEPHALOPATHY,NEPHROPATHY &NEED FOR
GASTROSURGEON EVALUATION &INTERVENTION FOR LIVER TRANSPLANT SURGERY.THIS
CASE WAS DISCUSSED WITHY DR.KISHAN GASTROENTEROLOGIST @ KHL &ADVISED
REFERRAL .SO PATIENT IS BEING REFERRED TO HIGHER CENTRE
When to Obtain Urgent Care
IN CASE OF ANY EMERGENCY IMMEDIATELY CONTACT YOUR CONSULTANT DOCTOR OR
ATTEND EMERGENCY DEPARTMENT.


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