Inv 26 for bedside for dr punima 2024.pptx

bedside is necessary

1. Investigations 26/02/25

2. Hemogram Investigations 17/5/23 15/7/23 22/02/24 2/5/24 9/8/24 10/2/25 19/2/25 25/2/25 Hb (g/dl) 10.1 10.1 10.8 7.9 10.1 10.0 10.1 10.0 MCV ( fl ) 80 77 81 71 83 83 78 81 RDW - - - - - 18 17.1 19.1 Hct (%) 31.7 31 33 29 32 33 32 33 TLC (/mm 3 ) 3700 5900 7800 5100 3400 4370 6490 4290 DLC (N/L) - 65/20 77/14 53/30 53/25 58/26 65/20 61/22 Plt (/mm 3 ) 96k 1.04L 1.25L 90k 75k 1.28L 1.14L 84k

3. Renal Function Test Investigations 17/5/23 15/07/23 22/2/24 9/8/24 2/5/24 10/02/25 25/02/25 Urea/Creatinine (mg/dl) 21/0.6 21/0.8 36/0.6 22/0.8 23/0.7 25/0.67 30/0.7 Na/K ( meq /L) - - 133/3.01 141/3.7 132/3.9 143/4.1 137/4.05 Ca/P (mg/dl) - - - - - 8.9/- - Mg - - - - - - -

4. Liver Function Test Inv 17/05/23 15/07/23 22/2/24 9/8/24 3/2/25 10/2/25 19/2/25 25/2/25 T.Bil /Dir (mg/dl) 4.9/- 9.7/- 3.6/- 10.1/6.7 8.4/4.5 5.9/3.7 5.4/3.3 8.2/3.3 AST/ALT (IU/L) -/145 -/120 -/28 -/105 89/70 133/92 114/79 185/124 ALP (IU/L) 766 1066 214 805 302 467 (40-128) 524 - T.P/Alb (mg/dl) 6.7/3.2 7.1/3.8 6.3/3.5 7.06/3.67 6.4/3.5 7.7/3.77 7.2/3.8 7.1/3.5 GGT (IU/L) - - - - - 255 -

5. Coagulogram Investigations 22/2/24 PT (sec) 14.1 PTI (%) - INR 1.17 PTTK (sec) 40.8 Investigations 25/02/24 PT (sec) 14 PTI (%) 80 INR 1.25 PTTK (sec) 49.2

6. Tumor markers CA19-9 – 1.25 (0-27) IU/ml CEA- 1.29 (0-4.7) ng/ml

7. Viral markers HbsAg – Neg Anti HCV- Neg HIV- Neg

8. Autoimmune markers ANA- Negative Anti LKM – Negative ASMA- Negative

9. Others IgG4- 1.11g/L (0.03-2.01)

10. Others JAK2V617F - Negative

11. Others Homocysteine- 11.14 umol /L (4.3-11.1)

12. USG (1/9/22) Liver 10.5cm, normal shape, size outline. Mild IHBRD GB normal in shape, size, outline CBD normal in calibre at porta hepatis, PV- MPV near porta shows thick wall with luminal narrowing. Multiple periportal collateral seen Spleen 14cm , no splenic varices seen Mild pelvic ascites Imp – Chronic portal vein thrombosis with mild splenomegaly

13. CECT Abdomen (4/9/22) Mild ascites Liver 13.3cm no focal lesion Bilobar IHBRS with central IHBR dilated upto porta hepatis PV shows filling defect from from confluence to porta hepatis ( pv thrombosis ) GB distended , normal wall thickness CBD 5mm Spleen 13.9cm with no focal lesion Imp – PV thrombosis with dilated bilobar central IHBR Mild splenomegaly, mild ascites

14. ERCP (24/5/23)

15. UGIE (23/02/24)

16. ERCP (1/5/24)

17. ERCP (24/5/24)

18. ERCP ( 05 /8/24)

19. ERCP ( 02 /09/24)

20. ERCP ( 04 /11/24)

21. ERCP ( 14/1/15) SVE negotiated to D2 10F stent removed with snare Contrast free selective CBD cannulation achieved with tome and GW Cholangiogram s/o stricture in LHD, RHD, CHD with prox biliary dilatation 8mm hurricane used to dilate CHD, LHD, RHD in serial manner Due to technical reason one 10Fx10cm DPT placed in LHD

22. ERCP (15/1/15) SVE negotiated to D2 Contrast free selective CBD cannulation achieved with tome and GW 3 more stents (two 10Fx10cm DPT, one 7Fx12cm SPT) placed alongside 10F stent

23. CEMRI Abdomen with MRCP (8/2/25) Liver 11.1cm, irregular outline, mild heterogenous signal intensity. Volume redistribution in the form of caudate lobe hypertrophy Portal vein replaced by multiple collaterals Hepatic veins normal Mild central IHBRD Multiple dilated tortuous collaterals in splenic hilum, perigastric , mesenteric and pericholecystic locations. A prominent collateral arising from proximal splenic vein is seen shuting with left renal vein (spontaneous shunt) Reteropancreatic splenic vein -11m GB distended, normal CBD (8.5mm) and CHD dilated with stent insitu Spleen 16.3cm, normal outline and intensity

24. CEMRI Abdomen with MRCP Imp – EHPVO with PCC S/P biliary stenting Splenomegaly with features of portal HTN Spontaneous lienorenal shunt with portosystemic collaterals

25. ERCP (14/2/25) SVE negotiated to D2 Previously placed 4 stents removed with snare Contrast free selective CBD cannulation achieved with tome and GW Cholangiogram s/o stricture in mid and upper CBD with dilated upstream CBD, CHD, RHD, LHD 4 DPT placed across stricture- 10F x7cm DPT, 10Fx10cm DPT (2), 7F x12cm DPT Free flow of bile noted mixed with pus