A 38 yr old male with vomitings
Case History and Clinical Findings
CHEIF COMPLAINTS-
PATIENT CAME TO CASUALITY WITH C/O 10-15 EPISODES OF VOMITINGS SINCE 1 DAY
HISTORY OF PRESENTING ILLNESS-
PATIENT WAS APPARENTLY ASSYMPTOMATIC 10 MONTHS BACK ,THEN HE DEVELOPED
YELLOWISH DISCOLOURATION OF EYES,URINE AND ABDOMINAL DISTENSION FOR WHICH
HE WENT TO HOSPITAL AND WAS DIAGNOSED WITH JAUNDICE FOR WHICH HE IS
EVALUATED AND UPPER GI ENDOSCOPY WAS DONE ON
12/7/22-IMPRESSION - LOW GRADE OESOPHAGEAL VARICES,MILD PHG
SINCE THRN HE IS HAVING SIMILAR EPISODES OF JAUNDICE ONCE IN A WHILE AND USG
WAS DONE MULTIPLE TIMES
USG IMPRESSION ON 6/12/22-MODERATE HEPATOSPLENOMEGALY,GALL BLADEER
SLUDGE,NO EVIDANCE OF CHOLEDOCHOLITHIASIS,B/L MINIMAL PLEURAL
EFFUSION[RT>LT],MINIMAL ASCITIES VISUALIZED.
ON 14/12/22 USG IMPRESSION -MODERATE HEPATOSPLENOMEGALY WITH FATTY
LIVER,ALTERED ECHO TEXTURE TO RULE OUT CLD CHANGES,MILD INTRA HEPATIC
BILIARY RETICULAR DILATATION IN LEFT LOBE OF LIVER,GB SLUDGE ,MILD
SPLENOMEGALY,MILD IHBRD NOTED IN THE LEFT LOBE OF LIVER.
ON 18/2/23-
HE PRESENTED TO ANOTHER HOSPITAL WITH COMPLAINTS OF PRODUCTIVE COUGH,
STREAKY[BLOOD] SPUTUM,INTERMITTENT FEVER SPIKES WITH CHILLS AND
RIGORS.PATIENT WAS STARTED ON IV ANTIBIOTICS
,PPI,ANTIFIBRYNOLYTICS,NEBULISATION,AND OTHER SUPPORTIVE CARE.ALL NESSESARY
INVESTIGATIONS WERE DONE.NA*-129,PT/INR-20.5/1.49,FIBRINOGEN-499,TOTAL BILIRUBIN-
8.4.
CT CHEST AORTOGRAM WAS DONE WHICH SHOWED B/L TREE IN BUD WITH DIFFUSE
GGO.SPUTUM WAS SENT FOR ANALYSIS,DENGUE IGM WAS POSITIVE.REPEAT CBP
SHOWED PCV-24,HB-9.10,TLC-6150.GENERAL PHYSICIAN CONSULTATION WAS TAKEN IN
VIEW OF DENGUE AND CONTINUED ON MEDICAL MANAGEMENT .PATEINT WAS
DISCHARGED IN STABLE CONDITION WITH FOLLOWING ADVICE
-TAB DOXYCYCLINE 100 MG/BD /5 DAYS
-TAB PAN 40 MG/OD/AT 7AM BEFORE BREAKFAST 5 DAYS
-TAB MONDESLOR OD/AT 7PM /5 DAYS
-SYP.ASCORIL-D 10 ML /TID
-TAB UDILIV 300MG/BD
PATIENT WAS ON ALCOHOLIC OBSTINENCE SINCE THEN AND SYMPTOMS GRADUALLY
DECREASED BUT SINCE 3 DAYS PATIENT WAS ON ALCOHOL BINGE AND VOMITINGS
STARTED FROM 3RD DAY NIGHT THAT IS FROM 6/4/23 TO 7/4/23 10-15 EPISODES OF
VOMITINGS WHICH WERE NON BILIOUS,NON PROJECTILE,DIDNOT CONTAIN FOOD
PARTICALS,MUCOUS GELLY LIKE CONSISTENCY,ONE OF THE EPISODES CONTAINED
BROWNISH BLACK JELLY LIKE MATERIAL AT THE END OF THE EPISOD , ASSOCIATED WITH
DIFFUSE ABDOMINAL PAIN
PAST HISTORY :
H/O SIMILAR COMPLAINTS IN THE 2 MONTHS BACK
N/K/C/O DM,HTN,TB,ASTHMA,EPLEPSY
PERSONAL HISTORY:
MIXED DIET
NORMAL APPETITE
BOWEL AND BLADDER HABITS REGULAR
ADDICTIONS-KNOWN ALCOHOLIC SINCE 20 YEARS
NO ALLERGIES
NO SIGNIFICANT FAMILY HISTORY
GENERAL EXAMINATION:
PT. IS CONSCIOUS/COHERENT/COPERATIVENO PALLOR, ICTERUS, CYNOSIS, CLUBBING,
LYMPHEDENOPATHY, PEDAL EDEMATEMP- 96.8FPR--120BPMBP-150/100MMHGSPO2-98% @
RAGRBS-100MG/DL
CVS- S1S2+,NO MURMURSRS- BAE+,NVBS HEARDP/A- SOFT,NON TENDER,BOWEL
SOUNDS+CNS- NO FOCAL NEUROLOGICAL DEFICITS
Investigation
2D ECHO
TRIVIAL MR;MILD TR PAH;MILD AR,NO RWMA,NO AS/MS
GOOD LV SYSTOLIC FUNCTIONSDIASTOLIC DYSFUNCTION PRESENT; NO PT
ULTRASOUND
MILD SPLEENOMEGALY
COARSE ECHOTEXTURE OF LIVER
LEFT RENAL CALCULUS
HEMOGRAM
HB;11.3
TLC;4700
PCV;32.6
RBC;3.5
PLATELET COUNT;1.5
Diagnosis
ACUTE GASTRITIS (RESOLVED)
CHRONIC DECOMPENSATED LIVER DISEASE WITH H/O HEPATOSPLENOMEGALY WITH LOW
GRADE ESOPHAGEAL VARICES
Treatment Given(Enter only Generic Name)
IVF IN NS /RL AT 50 ML/HR
INJ.PAN 40 MG IV BD
INJ.THAIMINE 200 MG IV BD
INJ.ZOFER 4 G IV TID
T.UDILIV 300 MG PO BD
T.DOLO 650 MG PO BD
SYP.LACTULOSE 15 ML PO HS
SYP .POTKLOR 20 MEQ /15 ML/PO/TID
Advice at Discharge
TAB.CINOD 10MG/PO/OD 8AM
TAB. PAN 40 MG PO OD AT 7AM BEFORE BREAKFAST FOR 1 WEEK
TAB .THAIMINE 200 MG PO OD AT 2PM FOR 1 WEEK
T.UDILIV 300 MG PO BD AT 8AM AND 8PM FOR 1 WEEK
T.DOLO 650 MG PO SOS
SYP.LACTULOSE 15 ML PO HS AT 9PM FOR 1 WEEK
2 SCOOPS PROTEIN POWDER IN GLASS OF MILK FOR 1 WEEK
Follow Up
REVIEW AFTER 1 WEEK TO GM OPD/SOS
When to Obtain Urgent Care
IN CASE OF ANY EMERGENCY IMMEDIATELY CONTACT YOUR CONSULTANT DOCTOR OR
ATTEND EMERGENCY DEPARTMENT.
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