Alcoholic Hepatitis and aki sec to gastroenteritis

  •  This is online E log book to discuss our patient’s de-identified health data shared after taking his/her/guardian’s signed informed consent. Here we discuss our individual patient’s problems through series of inputs from available global online community of experts with an aim to solve those patients clinical problems with collective current best evidence based inputs 

A 43 yr old male ,resident of nalgonda came to casuality with chief complaints of

  • loose stools since 20 days 

  •   Pedal edema since 20 days
  •    Abdominal distension since 20 days 

   History of presenting illness :  

 Patient was apparently asymptomatic 20 days back then he developed 
  • Loose stools watery in consistency 20 episodes per day 
  • sudden onset of swelling of bilateral lower limbs and gradually progressive up to bilateral knee,pitting type, non tender, 
  • associated with abdominal distension which is progressive.
  •  Not associated with facial puffiness , decreased urine output, SOB, orthopnoea, PND, palpitations,giddiness,sweating.
  • No H/o fever,pain abdomen,nausea, vomitimg

Past history:

  • No H/o similar compliants in the past
  • H/o of jaundice 2 years back
  • Last alcohol intake 2 days back
  • N/K/C/O DM, HTN, CVA, CAD
  • H/o TB 3 years back for which he took ATT for 6 months

Personal history:

  • Appetite : normal
  • Diet: mixed
  • Bowel&bladder: regular
  • Sleep: adequate
  • Addictions: regular alcohol intake since 15 years (180ml per day),   chewable tobacco 1-2 per day since 15 years

Family history:

Not relevant

General examination:

  • Pateint is conscious , coherent, co-operative , moderately built and well nourished
  • Pallor+
  • No icterus
  • No cyanosis, lymphadenopathy,clubbing of foot 
  • There is bilateral pitting edema up to knee






  • Vitals: 
                  Temp- afrbrile
                   PR- 100bpm
                   RR- 16cpm
                   BP-140/90 mm hg on left arm 
                    Spo2- 96%
                    GRBS- 190mg/dl

PER ABDOMEN: 
Inspection: 
  • Shape of abdomen- distended
  • Umblicus: inverted
  • Dilated veins+
  • No scars & sinuses
Palpation:
  • No local rise of temp
  • No tenderness
  • Liver not palpable 
  • Spleen not palpable 
Percussion: 
  • Liver span:9cms  

Auscultation:
  • Bowel sounds heard

CNS: NFD

CVS: s1,s2 heard, no murmurs 

RS: NVBS  , no creps

PROVISIONAL DIAGNOSIS:  ALCOHOLIC HEPATITIS ,
AKI SECONDARY TO ACUTE GASTROENTERITIS  
HFrEF SECONDARY TO CAD 
ALCOHOLIC AND TOBACCO DEPENDENCE SYNDROME 


INVESTIGATIONS: 

Hemogram
CUE
CBP
RFT
LFT
ECG
CXR PA VIEW
USG ABDOMEN
PT/ INR
APTT
BT/CT



On 04/07/2021 
 




USG : 

2D ECHO : 





TREATMENT
  • INJ THIAMINE 100 mg in 100 ml NS slow IV / TID
  • INJ OPTINEURON 1AMP in 100 ml NS slow IV / OD
  • INJ LASIX 40 mg
  • TAB. ALDACTONE 50 mg PO / BD
  • INJ PANTOP 40 mg IV/ OD
  • ABDOMINAL GIRTH MEASUREMENT DAILY
  • BP /PR/TEMP/ RR -4 hourly 
  • I/O CHARTHING


On 06/07/2021  : 


  PEDAL EDEMA DECREASED 

  STOOLS ( 2-3 episodes /day )

 Tremors+ 


O/E PT IS C,C,C

 AFEBRILE 

 BP 150/100mmhg 

PR 80bpm

RR 20cpm 

CVS :S1S2 heard 

RS :NVBS +

CNS :NAD

PA : soft distended 

        Free fluid +


 TREATMENT : 

1)PLENTY OF ORAL FLUIDS 

2)INJ.METROGYL 400mg /IV/TID 

3)INJ .CIPROFLOX 500mg /IV//OD 

4)INJ.PANTOP 40mg iv/OD

5)INJ.THIAMINE 1amp in 100ml NS IV/TID 

6)INJ.OPTINEURON 1ampin 100ml NS IV/od

7)TAB .SPORLAC DS PO/TID 

8)ORS SACHET 1 in 1L OF WATER 

9)TAB LOPERAMIDE.  2mg /po / SOS

10)BP/PR/TEMP/ RR 4 th hrly 

11)I/O CHARTING.  

  

*CORRECTED CALCIUM :7.9

*ENDOSCOPY : MALLORY WEISS TEAR HEALING PHASE 

                                   GASTRODUODENITIS 




On 07/07/2021 :


PEDAL EDEMA DECREASED 

  LOOSE STOOLS ( 2-3 episodes /day )

 Tremors+ 


O/E PT IS C,C,C

 AFEBRILE 

 BP 120/80

PR.  104

RR.   22 

CVS :S1S2 heard 

RS :NVBS +

CNS :NAD

PA : soft distended 

        Free fluid +

TREATMENT : 

  1. PLENTY OF ORAL FLUIDS 
  2. INJ.METROGYL 400mg /IV/TID 
  3. INJ .CIPROFLOX 500mg /IV//OD 
  4. INJ.PANTOP 40mg iv/OD 
  5. INJ.THIAMINE 1amp in 100ml NS IV/TID 
  6. INJ.OPTINEURON 1ampin 100ml NS IV/od
  7. TAB .SPORLAC DS PO/TID 
  8. ORS SACHET 1 in 1L OF WATER 
  9. TAB LOPERAMIDE.  2mg /po / Sos
  10. BP/PR/TEMP/ RR 4 th hrly 
  11. I/O CHARTING.  

On 08/07/2021 

PEDAL EDEMA DECREASED 

  STOOLS ( 2-3 episodes /day )soft consistency 

 Tremors+ 


O/E PT IS C,C,C

 AFEBRILE 

 BP 120/80

PR.  92 

RR.   22 cpm

CVS :S1S2 heard 

RS :NVBS +

CNS :NAD

PA : soft distended 

        Free fluid +

TREATMENT : 

1)PLENTY OF ORAL FLUIDS 

2)INJ.METROGYL 400mg /IV/TID 

3)INJ .CIPROFLOX 500mg /IV//OD 

4)INJ.PANTOP 40mg iv/OD

5)INJ.THIAMINE 1amp in 100ml NS IV/TID 

6)INJ.OPTINEURON 1ampin 100ml NS IV/od

7)TAB .SPORLAC DS PO/TID 

8)ORS SACHET 1 in 1L OF WATER 

9)TAB LOPERAMIDE.  2mg /po / SOS

10)BP/PR/TEMP/ RR 4 th hrly 

11)I/O CHARTING.  

  *12)TAB ECOSPIRIN 75mg/po/od 


 On 09/07/2021 :


 PEDAL EDEMA DECREASED 

 STOOLS 2-3. Episodes /day  soft in consistency 

Alcohol withdrawl tremors + 

  

O/E PT IS C,C,C 

 AFEBRILE 

 PR. 84bpm

RR.  20cpm

BP.   120/80

CVS :S1S2 heard 

RS :NVBS +

CNS :NAD

PA : soft distended 

        Free fluid +

TREATMENT : 

1)PLENTY OF ORAL FLUIDS 

2)INJ.METROGYL 400mg /IV/TID 

3)INJ .CIPROFLOX 500mg /IV//OD 

4)INJ.PANTOP 40mg iv/OD

5)INJ.THIAMINE 1amp in 100ml NS IV/TID 

6)INJ.OPTINEURON 1ampin 100ml NS IV/od

*7)TAB LORAZEPAM 2mg OD 

8)ORS SACHET 1 in 1L OF WATER 

*9)TAB ECOSPORIN 75 mg OD 

10)BP/PR/TEMP/ RR 4 th hrly 

11)I/O CHARTING. 


On 10/07/2021 :


STOOLS PASSED 

TREMORS +


O/E PT IS C,C,C 

 AFEBRILE 

 PR. 100bpm

RR. 24cpm

BP.  110/80

CVS :S1S2 heard 

RS :NVBS +

CNS :NAD

PA : soft ,non tender 


TREATMENT : 

1)PLENTY OF ORAL FLUIDS 

2)TAB PANTOP 40mg iv/OD

3)INJ.THIAMINE 1amp in 100ml NS IV/TID 

4)INJ.OPTINEURON 1ampin 100ml NS IV/od

5)TAB ECOSPORIN 75 mg OD 

6)TAB LORAZEPAM 2mg OD

7)BP/PR/TEMP/ RR 4 th hrly 

8)I/O CHARTING 


On 11/07/2021 :

 

 STOOLS PASSED 

TREMORS +


O/E PT IS C,C,C 

 AFEBRILE 

 PR 84 bpm

RR   21cpm

BP.    120/80 mmhg 

CVS :S1S2 heard 

RS :NVBS +

CNS :NAD

PA : soft ,non tender 

TREATMENT : 

1)PLENTY OF ORAL FLUIDS 

2)TAB PANTOP 40mg iv/OD

3)INJ.THIAMINE 1amp in 100ml NS IV/TID 

*4)TAB NEUROBION FORTE OD 

5)TAB ECOSPORIN 75 mg OD 

6)TAB LORAZEPAM 2mg OD 

6)BP/PR/TEMP/ RR 4 th hrly 

7)I/O CHARTING. 


Hb: #7.1

TLC:#20,700

Platelets:2.6

Dimorphic anemia 

Urea :18

Creatinine :0.8

Na+: 133

K+: 3.4

Cl-: 96 


On 12/07/2021 :


STOOLS PASSED 

TREMORS +


O/E PT IS C,C,C 

 AFEBRILE 

 PR.  68bpm

RR.   22 cpm 

BP.     120/90mmhg 

CVS :S1S2 heard 

RS :NVBS +

CNS :NAD

PA : soft ,non tender 


TREATMENT : 

1)FLUID RESTRICTION <1.5L/ day 

SALT RESTRICTION <2gm/day

2)Tab PAN 40mg iv/OD

*3)TAB. BENFOMETPLUS OD 

*4)TAB NEUROBION FORTE OD 

5)TAB ECOSPORIN 75 mg OD 

*6)TAB LIVOGEN OD 

*7)INJ. VITCOFOL 500mg IM/OD 

*8)TAB. LASIX 20mg OD 

*9)TAB. RIFAXIMINE 550mg BD 

6)BP/PR/TEMP/ RR 4 th hrly 

7)I/O CHARTING. 

  

Hb: #7.1

TLC:#20,700

Platelets:2.6

Dimorphic anemia 

  

Urea :#63

  Creatinine :#3.2


Na+: 140

K+: 4.3

Cl-:107


TB: #1.15

DB:#0.30

SGOT:#86

SGPT:24

ALP:#489

Total protiens :#5.2 

Albumin: #2.8 

 






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