CHRONIC ALCOHOLIC LIVER DISEASE WITH PORTAL HYPERTENSION
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50 year old male chronic alcoholic since 35 yrs came to opd with the chief complaints of sob ,abdominal distension and pedal edema since 18 months which increased in past 1 month
Patients was apparently asymptomatic 18 months back and then he developed abdominal distension and pedal edema for which he went to a hospital where he diagnosed with
Chronic liver disease with portal hypertension
Oesophageal varices grade 3
s/p EVL banding
And was given symptomatic treatment.
Patient continued to take alcohol and was asymptomatic until 6 months back when he again had abdominal distension, pedal edema for which he went to a hospital.
Treated conservatively and was discharged.
3 months later he was admitted in our hospital with similar complaints of sob, abdominal distension, pedal edema and h/o RTA
Treated symptomatically and was discharged.
Used treatment for 20 days & stopped.
Patient stopped using medication from last 2 months & continued to take alcohol until 1 week back and again came to our hospital with increased sob ,abdominal distension and pedal edema since 1 month.
No history of fever, vomitings
No h/o hematemesis/malena
No other complaints
Past history :
Appendicectomy 25years back
Not a known case of HTN, DM, Thyroid, asthma, epilepsy
Family history :
No significant history
Personal history
Diet : mixed
Appetite : Normal
Sleep : adequate
Addiction : chronic alcoholic
Toddy two bottles daily
Alcohol - 180 ml per day
General examination
Patient is conscious, coherent, cooperative.
No pallor
No icterus
No clubbing, cyanosis
No koilonychia
No lymphadenopathy
Edema present - pitting type
Involving both legs below knee
Vitals
Temperature : afebrile
Respiratory rate : 18 cpm
Blood pressure : 120/90 mmHg
Pulse :82bpm
Per Abdomen :
Distended abdomen
Scars present
Engorged veins are seen
Umbilical hernia present
Fluid thrill present
Investigations
CBP
Ultrasound
No dilated bowel loops
Gross ascites is seen
Umbilical hernia is present
Chronic liver disease with portal
hypertension
LFT
APTT
PT
CUE
Serum creatinine
Ascitic tap
Ascitic fluid cytology
LDH
0.45
Ascitic fluid sugar and protein
Sugar - 100
Protein - 2.3
Provisional diagnosis
Chronic liver disease with portal hypertension
Oesophageal varices grade 3
s/p EVL banding
Treatment
Day 1
Fluid restriction
Salt restriction
Tab. Lasilactone 20/50 BD
Tab. Pan 40mg OD
Tab. Udiliv 300mg BD
Tab. Rifagut 550mg BD
Inj. Optineuron 1amp 100ml IV OD
Inj. Thiamine 1amp 100ml IV TID
Daily abdominal girth and weight monitoring
Monitor BP, PR, RR
Day 2
Fluid restriction
Salt restriction
Tab. Lasilactone 20/50 BD
Tab. Pan 40mg OD
Tab. Udiliv 300mg BD
Tab. Rifagut 550mg BD
Inj. Optineuron 1amp 100ml IV OD
Inj. Thiamine 1amp 100ml IV TID
Daily abdominal girth and weight monitoring
Monitor BP, PR, RR
Day 3
Fluid restriction
Salt restriction
Tab. Lasilactone 20/50 BD
Tab. Pan 40mg OD
Tab. Udiliv 300mg BD
Tab. Rifagut 550mg BD
Inj. Optineuron 1amp 100ml IV OD
Inj. Thiamine 1amp 100ml IV TID
Daily abdominal girth and weight monitoring
Monitor BP, PR, RR
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