Abhishek Case Presentation on fatty liver grade 1 .

Case on fatty liver grade 1 .

1. Case Presentation on Fatty L iver G rad e-1 Name :- Abhishek Pandey Year :- 4 th Year ( Pharm . D ) En. No. :- 202003102510007

2. PATIENT DEMOGRAPHIC DETAILS NAME : Pravinchandra I shwarlal H emnani AGE: 61 years SEX: Male C/O: loose stool 8-10 times since 2-3 days, nausea, fever, abdomen pain since 4-6 months. UNIT : SP DATE OF ADMISSION: 27/12/2022 SOCIAL Hx: Alcohol consumption since 15 years FAMILY Hx: nil ALLERGY: nil PMHx: nil MEDICATION Hx: nil

3. VITAL DAY NOTE DATE 27/12 28/12 29/12 30/12 BP (mmHg) 100/70 110/70 122/80 120/84 Pulse (beats/min) 93 - - - Spo2 99% 99% 98% 98% Temperature - - - -

4. HAEMOGRAM PROFILE Test 27/12 29/12 Reference Neutrophils 65 % 48 % 55-70 % Eosinophils 3 % 15% 1-6 % Monocytes 9 % 11% 2-8 % M.C.H.C 32 % 31.90 % 32-36 % PCT 3.37 ml/l 2.9 ml/l 1.08-2.82 ml/l

5. Examination of stool Test 28/12 Physical examination: colour: greenish consistency: watery Mucus Present Pus cells 4-6 Red blood cells Present (2-4) Epithelial cells occasional

6. BIOCHEM PROFILE TEST 27/12 Reference Serum Chloride 134 mEq /L 135-145 mEq /L R HEUMATOLOGY TEST 23/12 REFERENCE C.R.P 14.1 mg/dL <5.0 mg/dL

7. USG ABDOMEN Performed on 28/12 Suggests that :- Changes in enteritis Fatty liver grade 1

8. Generic name dose Freq. route 27/12 28/12 29/12 30/12 Inj. Ceftriaxone 1 gm BD I.V     Inj. Metronidazole 1 amp TDS I.V     Inj. Rabeprazole 20 mg BD I.V     Inj. Granisetron 2 amp TDS I.V     IVF RL NS 80 ml/hr I.V     Cap. Racecadotril 100 mg 1-0-1 PO     Cap. Doxycycline 100 mg 1-0-1 PO     Entroflora susp 1-1-1 PO     Tab. Loperamine 2 tab stat  ORS powder   

9. SUBJECTIVE EVIDENCE OBJECTIVE EVIDENCE loose stool 8-10 times since 2-3 days,  Serum Chloride abdomen pain since 4-6 months Stool examination: mucus: present Pus cells: present Red blood cells: present Epithelial cells: occasional fever USG Abdomen: Fatty liver grade 1 nausea SOAP FORMAT :-

10. ASSESSMENT:- Based on subjective and objective evidence the patient was diagnosed with fatty liver and mild inflammation and oedematous terminal ileum

11. Goals of treatment :- To prevent further liver complication To relieve patient from sign and symptoms To improve patients quality of life To reduce inflammation and infection

12. Non pharmacological treatment :- For fatty liver :- To maintain proper food diet Send patient to rehab centre Avoid alcohol consumption Daily exercise to loss weight For inflammation in ileum :- Limit dairy products Eat small meals Drink plenty of fluid Take multivitamin

13. Pharmacological treatment :- For Inflammation in ileum/ileitis :- Inj. Ceftriaxone Inj. Metronidazole Inj. Rabeprazole Cap. Doxycycline For Diarrhea Cap. Racecadotril For Nausea Inj. granistetron

14. For electrolyte balance normal saline ORS powder

15. Patient counselling:- ABOUT DISEASE: ILEITIS: inflammation of the ileum Fatty liver: F atty liver disease is a common condition caused by having too much fat build up in your liver.  

16. Drug related:- Ceftriaxone: possible side effect of Black/starry stools ,sore throat, unusual tiredness or weakness Metronidazole: possible side effects are Stomach pain , palpitation, headache Rabeprazole: possible side effects are Tingling of hands or feet, hoarseness, unusual weight gain/loss Granisetron: possible side effects are headache, constipation, stomach pain Doxycycline: possible side effects are headache, skin being sensitive to light Entroflora: possible side effects are abdominal cramps, taste disturbance Loperamide: possible side effects are Itching, rash, low urine volume

17. Monitoring parameter: ILEITIS FATTY LIVER DISEASE CRP Total Bilirubin Albumin HDL Hemoglobin LDL Daily stool AST ALT GGT HB Triglycerides About disease

18. About drug Ceftriaxone CBC,RFT,LFT Metronidazole Prothrombin time, INR , ECG Rabeprazole E CG , Serum Mg Granisetron ECG , Serum k, Serum Mg Loperamide Na , Cl level should be monitored

19. Lifestyle modification:- No alcohol intake or consumption Eat green leafy vegetables Take 8hrs of sleep daily Have low fibre diet Do exercise daily Avoid caffeine and energy drinks Avoid taking large meals instead eat more small meal

20. THANKYOU