Case Presentation Anees 2.pptx fo study just

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1. Case Presentation Anees ul Islam

2. Biodata and Presenting Complaints A 40 year old female ,known case of hepC ,resident of karachi,presented to OPD with complains of : Abdominal distention 1 month Fever 10 days Cough 10 days Shortness of Breath 10 days

3. History Of Presenting Complaints According to my patient,She was in her usual state of health 1 month back when she developed abdominal distention ,which was gradual in onset progressive in nature and associated with feeling of fullness. 10 days ago,she developed fever which was low grade documented upto 100 F , 1-2 spikes per day and relieved by taking anti pyretics.fever is associated with Cough and shortness of breath.Cough is dry and mild in severity and SOB is on both exertion and rest,associated with B/L edema upto shin. No hx of jaundice,hematemesis,melena,ALOC , orthopnea, PND,no biomass exposure.

4. Systemic Review GIT : no hx of jaundice,hematemesis , melena,vomiting , diarrhea Respiratory : Cough + ve , SOB + ve , no hemoptysis CVS : SOB + ve , Pedal edema + ve , No Orthopnea,No PND CNS : Unremarkable MSK : Unremarkable GU : Unremarkable Endocrine : Unremarkable

5. Past History Hx of Hep c 8 years ago,treated with oral medications. No hx of other Chronic Diseases. No blood transfusion Hx No Surgical Hx No Allergy Hx

6. Personal History Hx of gutka addiction Undocumented Weight loss hx Ocassional constipation hx Family History -1 brother ,alive and Healthy -No Hx of chronic disease running in family

7. Examination A young age female of thin and lean built lying on bed in respiratory distress, concious and alert. Vitals BP = 110/70 mmhg , Pulse =112 bpm, RR=38 bpm, Temp = 101

8. Subvitals Anemia + ve , Jaundice – ve , Clubbing – ve LN + ve ( b/l post cervical,non matted), Thyroid swelling – ve.Edema Neck veins are engorged Palmer erythema + ve No dupytren contracture,Xanthelesma,caput medusa

9. Cont. Abdomen : Distended ,umbilicus centrally placed,no caput medusa. It is soft ,mildly tender at RUQ ,spleen palpable 1 finger below costal margin.shifting dullness + ve , Gut sounds audible. Respiratory : Normal shaped chest, decreased movement on right side,trachea centrally placed. Stony dull percussion on right side.Breath sound decreased on right side below 2 nd ICS, + ve VR CVS :Apex beat at 5 th ICS medial to MCL, S1+S2+0, Tachycardic CNS : GCS 15/15 , grossly intact

10. Case Summary A 40 year old female kc of Hep C presented with abd distention for 1 month and fever,cough,SOB for 10 days. Examination shows tachypnea,tachycardia,fever and distended abdomen with mild tenderness at ruq , decreased chest movement and breath sounds at right chest .

11. Differential Diagnosis ??

12. Differential Diagnosis : CAP with effusion DCLD 2ndry to hep C Dcld with hepatic hydrothorax Rule out Hepatoma

13. Labs Parameters Values Normal Range Hb 8.4 12-15 mg/dl PCV 27 36-46 % MCV 90 80-100 fl MCH 32 27-32 pg TLC 8.4 4-11 x10^9 /L PLAT 118 150-400 x10^9/L PT 14.4 11-13.5 sec APTT 37 25-35 INR 1.38 0.8-1.2

14. Cont. Parameter Value Normal range Total bilirubin 3.4 0.2-1.2 mg/dl Direct bili 2.6 0-0.3 mg/dl Indirect bili 0.8 0.2-0.8mg/dl SGPT(ALT) 23 7-56 U/L SGOT(AST) 5-40 U/L ALP 145 44-147 U/L T. Protein 6.1 6.4-8.3 g/dl Albumin 2.1 3.5-5 g/dl Globulin 4.0 2-3.5 g/dl BUN Cr 7 0.7 12-41 mg/dl 0.6-1.1 mg/dl Na K Cl 132 2.7 101 136-146mEq/L 3.5-5.1 mEq /L 98-107 mEq /L

15. Others Anti HcV = Reactive MP = - ve Hba1c = 4.6 Afp levels : Normal

16. Provisional Diagnosis DCLD Hepatic Hydrothorax

17. Treatment Inj Tanzo 4.5 gm IV 8 hourly Nebs with ipneb 6 hourly Inj Lasix 40 mg OD Inj Aldactone 100mg 1+0+0 Inj Risek 40 mg OD 1+0+0 Tab Carveda 6.25mg BD Syp duphalec 30ml HS Inj sandostatin 0.1 mcg S/C OD Vit K 10mg Od ( for 3 days) THERAPEUTIC DRAIN (150 ml, 1litre)

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