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A case of alcoholic liver cirrhosis

 This is an online E-log entry blog to discuss and understand the clinical data analysis of a patient, to develop competency in comprehending clinical problems, and to provide evidence-based inputs in order to come up with a diagnosis and effective treatment plan to the best of my ability.

A 46-year-old male who is a known case of liver cirrhosis presented to the casualty ward with the chief complaints of Grade IV shortness of breath, yellowish discoloration of eyes, bilateral pedal edema, and abdominal pain for the past 10 days

HISTORY OF PRESENTING ILLNESS:

The patient was his usual self 14 days ago when he developed a fever that was insidious in onset, not associated with chills or rigor.
10 days ago, he developed abdominal distension and shortness of breath (Grade 4) that was insidious in onset and gradually progressive.
This was associated with yellowish discoloration of the patient's eyes, nausea, and pitting type bilateral pedal edema.
Not associated with vomiting.

PAST HISTORY:

  • Known case of alcoholic liver cirrhosis for the past 3 years
  • Known case of Type 2 Diabetes for the past 3 years and is compliant with his medication
  • He has had a similar complaint of a yellowish tinge of eyes 1 year ago, for which he used herbal medication
  • He was vaccinated against Covid-19 4 days before the onset of his fever
  • No history of hypertension, CAD, TB, or asthma

PERSONAL HISTORY:

  • Diet: Mixed
  • Appetite: Decreased
  • Sleep: Regular
  • Bowel and bladder: Regular
  • Addictions: The patient has a history of alcohol intake that began 20 years ago and has been consistent with him drinking 90ml of whiskey 2-3 times a week. He has been chewing tobacco and has been a chain smoker for the past 20 years, smoking 2 packs per day.

DRUG HISTORY:

  • On oral hypoglycemic for DM2 for three years, takes Glimestar M1(Glimepiride and Metformin) tablets
  • No known drug allergies

FAMILY HISTORY:

No similar complaints in the family
No H/O diabetes or liver cirrhosis in the family

GENERAL EXAMINATION: (at the time of admission)

The patient was examined in a well-lit room, with informed consent.

  1. Conscious and cooperative but incoherent with altered sensorium
  2. Oriented to time, person and place.
  3. The patient appears malnourished

  • Pallor: Absent
  • Icterus: Present
  • Cyanosis: Absent
  • Clubbing: Absent
  • Lymphadenopathy: Absent
  • Edema: Pitting type, bilateral
  • Pupils: Normal in size, reactive to light
  • Dehydration: Mild

Vitals: (at the time of admission)

  • Temperature (F): 99.6
  • PR: 98/min
  • RR: 22 cycles/min
  • BP: 140/90 bpm
  • SpO2: 96% at RA
  • GRBS: 229mg%

SYSTEMIC EXAMINATION: (at time of admission)

  • CVS: S1, S2 heard
  • Respiratory: Dyspnoea
    Position of the trachea: Central
    vesicular breath sounds are heard
    Bilateral Air Entry positive
  • Per Abdomen: Distended
    Free fluid present
    Bowel sounds are heard
  • CNS: Normal

INVESTIGATIONS: 
1) HbA1c


2) APTT


3) Serum Electrolytes



4) Blood Urea and Serum Creatinine


5) ECG


6) LFT


7) Bleeding time and Clotting time


8) Prothrombin Time



9) USG Report




PROVISIONAL DIAGNOSIS: Jaundice under evaluation in a case of exacerbated alcoholic liver cirrhosis

TREATMENT: 
  • IVF Ions@ 50ml/hr
  • Fluid restriction (2L/day)
  • Salt restriction (2g/day)
  • INJ. PAN 40mg IV OD
  • SYRUP LACTULOSE 10ml PO BD
  • TAB UDILIV 300mg PO BD (Ursodeoxycholic acid)
  • TAB LASI LACTONE 20/50mg OP BD (Furosemide)
  • INJ HUMAN ACTRAPID INSULIN SC
  • GRBS Charting 6th hourly
  • BP Charting 8th hourly
  • Monitor Vitals
  • TAB DOLO 650mg PO SOS
I would like to thank Dr. Raveen sir, Dr. Aashitha ma'am, and Dr. Arun sir for providing the details for this case.

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