38 year old male with chronic liver disease

April 09, 2023

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CASE:

This is a case of a 38 year old male with complaints of abdominal pain and vomiting 10-15 episodes since 07/04/2023.

HISTORY OF PRESENTING ILLNESS:

Patient was apparently asymptomatic 9 months back then he developed jaundice with yellowish discoloration of eyes and urine , associated with pruritis for which he went for evaluation and upper GI endoscopy was done on 12/7/22 and given impression of low grade esophageal varices,mild PHG since then 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 bladder sludge ,no evidence 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 heptaic biliary reticular dilatation in left lobe of liver ,gn sludge ,mild splenomegaly ,mild IHBRD noted in the left lobe of liver.

On 18/2/23 :-

On 18/02/2023 He presented to another hospital with complaints of Productive cough, streaky (blood) sputum, intermittent fever spikes with chills & rigors. Patient was admitted there for further management.

Patient was started on IV antibiotics, PPI, antifibrinolytics, nebulisation and other supportive care. All necessary investigations were done. Na*: 129. PT / IN - 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. Hepatologist consultation was taken and advised for medical management. Patient was discharged in stable condition with the following advice.

-Tab. Doxycycline 100mg twice daily for 5 days -Tab. Pan 40mg once daily at 7am (½hr before breakfast) for 5 days

-Tab. Mondeslor 1 tab once daily at 7pm for 5 days

-Syp. Ascoril - D 10ml thrice daily

-Tab. Udiliv 300mg 2tab twice daily

Patient was on alcoholic abstinence 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 , didn't contain food particals, mucous gelly like consistency, one of the episode contained brownish black jelly like material at the end of the episode associated with mild abdominal pain .

Past history:- Not a known case of DM,HTN,TB, Asthma, epilepsy

Personal history:-

Diet-mixed

Appetite:- reduced since 3 days

Sleep :- adequate

Bowel and bladder movement-regular

Addictions:- drinks alcohol since 20 years

General examination:-

Patient is conscious, coherent,cooperative

Well built and well nourished