Presentation Esophageal Varices (1).pptx

Esophageal varices

1. PATIENT PRESENTATION BY; NABISERE VIVIAN MBCHB III DATE;16/11/2023 MINI ROUND CHAIRMAN ;PROF KAGIMU MAJID

2. PATIENT WITH THE DISEASE 4. FAMILY HISTORY Mr. Kitara Isaa c is a 45 year old male, a muganda by tribe He is an unmarried man, Cohabits w ith his girlfriend, Nabuth Olivia and a father of 5 children. His father, Namutale Charles is alive, but his mother, Namutebi Christi ne, died of unknown illness. He is the 8th born of 13 children; 3 of his siblings died of Malaria, other s are alive and Healthy. H e reports no history of any familial illnesses.

3. 5.SOCIAL AND OCCUPATIONAL HISTORY Mr. Kitar a Lives in a 4-bedroom house in Mukono. He is a small scale farmer ( rears som e cows and grows some crops) who works near Ggaba. He stopped in Primary Seven. Knows that living and working near lake contributed to his illness. Concerned that he cannot leave because it's his place of work. Failure to work because of illness He is a practicing Anglican, and His financial support is from himself and his friends. His best friend is Mr. Bakayana. His fears are failu re to heal death and he repo rted no enemies. He watches football and plays ludo in his leisure time. History of 20 years of alco hol intake (one bottle a week): but stopped. No history of smoking.

4. DISEASE OF THE PATIENT 1.PRESENTING COMPLAINTS Hematemesis for 1 day Yellowing of eyes for 2 days

5. 2.HISTORY OF PRESENTING COMPLAINTS The patient complains of of one episode of vomiting a mugful of blood in one day. This was associated with odynophagia and dysphagia while eating and yellowing of eyes for 2 days that occurred several days before hematemesis. He also reported low appetite for 2 weeks and chills for 3days. He doesn't know the color of stool. However, there was no abdominal pain, no significant weight loss, no constipation or diarrhea, and no abdominal distention.

6. REVIEW OF OTHER SYSTEMS Remarkable findings include: Increased thirst, diz ziness on walking long distances for 1 week, headaches on overthinking. Palpitations, easily gets tired and swelling of feet on walking long distances. However, he reported no night sweats, no change in urine colour, no abnormal discharges, no mental confusion.

7. 3.Past medical history Known hypertensive on unknown medication with no hist ory of other chronic illnesses. Within the past one month, previously admitted in Nsambya Hospital for one day for similar complaints, later admitted in Kiruddu for a week, transfusion of 5 units of blood and discharged with improvement. He reported use of Herbal medicine for ulcers. He had a traumatic road accident in 2016 where he almost lost his foot.

8. EXAMINATION FINDINGS GENERAL EXAMINATION A sick looking adult male, well nourished, and no dehydration with fine hair, conjuctival pallor. No jaundice, no finger clubbing, no cyanosis and no lymphadenopathy. Temp: 36.7 °C Pulse rate;111bpm Respiratory rate; 18 breaths per minute SPO2; 100 B.P: 127/77 mmHg

9. ABDOMINAL EXAMINATION On inspection; well rounded abdomen, moving with respiration. On palpation; Nothing remarkable On percussion; nothing significant On Auscultation; Bowel sounds were present.

10. INVESTIGATIONS Upper GI ENDOSCOPY Complete Blood Count Results Endoscopy findings/dx Medium sized esophageal varices seen.

11. DIAGNOSIS Liver periportal fibrosis secondary to Schistosomiasis, complicated portal hypertension with bleeding esophageal varices.

12. MANAGEMENT Managing the patient with the disease Give information to the patient about the disease Address the concerns of the patient Share understanding of the doctors plan ,investigations, management and monitoring plan with the patient. Share decision making with the patient. Encourage prayer.

13. Management plan Managing the disease of the patient Fluids?? Blood?? Give propanolol Variceal banding

14. MONITORING PLAN To advise the patient to seek medical attention as soon as possible if the symptoms persist in order to be able to monitor his symptoms.

15. THE END THANK YOU