CASE PRESENTATION ON MILD HEPATOMEGALY 54454.pptx

Explore this informative Slide share presentation to delve into the intricacies of Hepatomegaly, a condition characterized by an enlarged liver. This comprehensive slide deck covers the causes, symptoms, diagnostic approaches, and management strategies related to Hepatomegaly. Gain valuable insights into liver health, medical imaging, and associated pathologies. Whether you're a healthcare professional or some one curious about liver conditions, this presentation provides a detailed overview to enhance your understanding. Navigate through a visual journey that outlines the diverse symptoms associated with hepatomegaly, enabling a nuanced understanding of clinical presentations. The presentation extends beyond diagnosis to encompass management strategies, emphasizing the importance of a multidisciplinary approach in treating Hepatomegaly.

1. PRESENTED BY; P. KRISHNA KEERTHI PHARM D NARAYANA PHARMACY COLLEGE CASE PRESENTATION ON MILD HEPATOMEGALY

2. Hepatomegaly is the condition of having an “ Enlarged liver”. It is a non specific medical sign having many causes, which can broadly be broken down into infection, direct toxicity, hepatic tumours, or metabolic disorder. Often , hepatomegaly will present as an abdominal mass. Depending on the cause, it may sometimes present along with jaundice. INTRODUCTION

3. NORMAL LIVER SIZE( age related ranges): 1 week of age : 4.5 – 5cm. At 5 years of age : 6 – 8 cm. 12 years , boys: 7-9 cm girls : 6-8 cm Above 12 years, boys : 7- 10.5 cm girls: 6- 9.5 cm. LOCATION: right upper quadrant of the abdomen. Liver typically extends from the fifth intercostal space to the midclavicular line.

4. HEPATOMEGALY LIVER SIZE: >15 cm - mild hepatomegaly Location: right hypochondriac region , epigastric region, left hypochondriac region. It extents upper border 6 th rib , inferior border- crosses midline at the level of transpyloric plane ( at the level of L1 vertebrae ).

5. In these case, liver enlargement may be attributed to defects in single genes – HEMO CHROMATOSIS- HFE gene (6p21. 3). HEMOJUVELIN (1q21). HEPCIDIN( 19q13). INTRODUCTION

6. EPIDEMIOLOGY

7. Abdominal pain Poor appetite Shortness of breath Fatigue Nausea, weight loss Dark urine, pale stool Increase in abdominal size Jaundice SYMPTOMS

8. INFECTIVE- along the biliary tree( Cholangitis ),along portal vein ( amoebiasis, bacterial infections ),along hepatic artery- bacterial(Typhoid, TB, syphilis), viral ( infective hepatitis, infectious mononucleosis), protozoal( malaria), fungal (actinomycosis, histoplasmosis ), parasitic ( Echinococcosis- it means cystic form ). CAUSES

9. CONGESTIVE - congestive cardiac failure, cardiomyopathy, congestive pericarditis. DEGENERATIVE AND INFILTRATIVE – alcoholic fatty liver, lymphomas, Leukemias , multiple myeloma. STORAGE DISORDERS- Neimann pick disease, Gaucher’s disease, Amylodosis . CAUSES

10. NEOPLASIA- hepatocellular carcinoma, cholangio carcinoma. TOXINS- alcohol , arsenic, phosphorous, chlorpromazine. CAUSES

11. PATHOPHYSIOLOGY

12. RISK FACTORS

13. DIPPING METHOD: When the organ is enlarged , assess the following: Edge or border ( sharp / rounded). Surface ( smooth/ nodular). Consistensy ( soft / hard). Presence of tenderness. Movement of respiration. PHYSICAL EXAMINATION

14. A complete blood count to check for an abnormal number of blood cells. Liver enzymes to evaluate liver function. Abdominal X- ray. CT- scan high resolution images of abdomen. MRI Ultrasound – the use of sound waves to evaluate the liver and abdominal organs. Taking a sample, or biopsy, of the liver tissue for further analysis. DIAGNOSIS

15. Depends on underlying causes.. HEPATITIS : Anti viral drugs, depend upon types of hepatitis treated. Alcoholic liver disease: Behavioural therapy( motivational enhancement therapy), family therapy, group therapy. TREATMENT

16. NON ALCOHOLIC FATTY LIVER DISEASE: Reducing the intake of cholesterol and fats. Maintaining a moderate weight. Controlling blood sugar levels Managing underlying health conditions, such as type-2 diabetes ( insulin therapy- Human Actrapid INJ ). TREATMENT

17. NEOPLASIA (Cancer): Chemotherapy Radiation therapy Immunotherapy Surgery to remove the tumour Liver transplantation TREATMENT

18. HEART FAILURE: ACE Inhibitors Beta blockers Diuretics Angiotensin 2 receptor blockers Lifestyle changes In some cases , surgery to correct irregularities or blocked arteries. TREATMENT

19. SUBJECTIVE EVALUATION: A male patient ( Rupesh Kumar ) , age 23 years admitted in the general medicine ward with the chief complaints of weakness and unable to walk since 1 week , severe abdominal pain, breathlessness and fever since 10 days, vomiting 2 episodes per day. Known alcoholic and smoking since 10 years. SOAP NOTES EVALUATION

20. OBJECTIVE EVALUATION: On physical examination patient was found to be conscious and coherent , temperature was found to be increased (102). Blood pressure- 130/70 Pulse rate- 76 bpm Respiratory rate- 18 breaths per min On systemic examination: CVS – S1 S2 + CNS- normal RS – BLAE+ SOAP NOTES EVALUATION

21. OBJECTIVE EVALUATION: On laboratory investigation ; Hb – 8g/dl ESR- 28mm/hr RBS- 108mg/dl Bleeding time- 2’-40’’ Serum bilirubin – 0.8mg/dl Serum creatinine- 1.1 mg/dl SOAP NOTES EVALUATION

22. ASSESMENT: Based on subjective and objective evaluation the patient was diagnosed as Mild hepatomegaly. SOAP NOTES EVALUATION

23. PLANNING: ON DAY-1: INJ DOXYCYCLINE – it is an antibiotic with 1g dose given twice a day, it has common adr’s of stomach upset, Diarrhoea, nausea, vomiting, difficulty in swallowing. INJ PANTOP – it is an anti ulcerative agent with 40mg dose given once a daily, it has common adr’s of nausea, headache and dizziness. INJ TRAMADOL- it is analgesic with 500mg dose given once a day, it has common adr’s of dizziness, constipation, sweating, dry mouth. SOAP NOTES EVALUATION

24. INJ ONDONSERTON- it is an anti emetic drug with 4mg dose given twice a day, it has common adr’s of headache, chills, constipation. SYP SUCRALFATE- it is an anti ulcerative 10ml dose given thrice a day, it has common adr’s of constipation. TAB PARACETAMOL – it is an antipyretic 500mg dose given thrice a day , it has common adr’s of dark urine, nausea, loss of appetite. ON DAY-2: - same treatment was continued INJ PIPTAZ (4.5g twice a day) and INJ AMIKACIN (500mg once a day) were added. Both are antibiotics , common adr’s of diarrhea , pruritis, hearing, rashes.

25. ON DAY-3: Same treatment was continued. Add INJ DICLOFENAC -2cc dose , once a day. It is an non-steroidal anti inflammatory drug, it has common adr’s of edema , constipation, heart burn. ON DAY-4, 5,6: Same treatment was continued.

26. ON DAY- 7: Patient was feeling better and discharged with following medication; TAB PANTOP- 40mg / OD TAB B COMPLEX – 67.4 mg / OD TAB CALCIUM – 500mg / OD TAB DICLOFENAC – 20mg SOS TAB PARACETAMOL – 500mg SOS

27. Physician did not prescribed any vitamin supplements even though patient Hb level was found to be low. Physician stopped the INJ tramadol on day 2 even though patient complaints of severe pain. ERRORS

28. On day 3 patient was given with vitamin supplements. INTERVENTIONS

29. DRUG-DRUG: Ondansetron reduce the effects of Tramadol. Ondansetron + tramadol = increase risk of serotonin syndrome and heart beat. Take doxycycline at least 2 hrs before sucralfate. Doxycycline + sucralfate = sucralfate that contain alluminium may interfere with absorption of doxycycline into the blood stream and reduce its effect. DRUG-FOOD: Tramadol + alcohol = increase the CNS effects such as dizziness, drowsiness, difficulty in concentrating. INTERACTIONS

30. Avoid alcohol and smoking consumption. Follow the low salt diet. Take plenty of water. Take fresh and uncontaminated food. Maintain body weight Treat the previous diseases Go for regular checkup Don’t skip the dose. Take medications regularly. Avoid sexual contact. REGARDING LIFE STYLE MODIFICATIONS

31. THANK YOU