30yr F h/o hematemesis ,hematochezia, now came with c/o gen.weakness ,abo.distention her Hb-3.0,RBC-1.94,WBC-2500,plt-76000. Usg of abd-fatty liver ,splenomegaly,mod.ascites 16mm gall stone.. XRC-normall wht is d/d ? wht :tretment can?plz reply

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If pt is bleeding profusely BT s after cross match. All investigations Cbc Lft Coag profile Kft(Rft) Bsr S proteins Correction of the shock Maintain o2 sat Iv fluid till BT Insertion of sangestaken tube Foley's cath ins once pt settes tapping of the fluid. post for scopy and inj of sclerosing agent in the oes varices partial splenectomy

this clinical picture is suggestive for IBD

Haemetemesis cholelithias cholelithiasis anaemia thrombocytopenia pancytopenai ascites hepatosplenomegaly investigation hida scan lft rft ldh ascites tapping cbnat enteroscopic examination admit 3 point of blood transfusion find out cause aft cirrhosis of liver dd tb abdomen dd malignancy dd cholelithiasis dd portal hypertension

pancytopenia,could be blood dyscrasias,as there was no portal hypertension by scan,needs bone marrow biopsy once patient is stabilized,give packed cells,ffpcryo 1:1:1 ratio,check for coagulation profile,lft, peripheral smear for abnormal cells if the pt is not in shock ,then it must be a chronic anemia but need to get hemostasis if oesophagus varices stat endoscopy,no varices,then blood dyscrasias

thank you...

bilious/gallstone indused gastritis/ pancreatitis with gastric/duodenal ulcer, stabilise the patient, xray erect abdmen sr amylase , lipase, do upper GI endoscopy , if bleeding ulcer is present treat surgically.

GI bleeding mandates upper GI and lower GI endoscopy. I would get a CT scan with angio to see for evidence of AV malformations or pseudo aneurysm. The size of the spleen doesn't indicate severe portal hypertension. Get coagulation studies done, rule out folic acid and b12 deficiency. Get the usual blood tests to establish normal organ function. Treat according to investigation

Portal hypertension with oesophageal varices.

With GB stone.

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It appears it is a case of coagulation disorder Get a coagulation profile As there is anaemia be take proper care in giving blood & blood products immediately plan for Pro& Platelets as the count is low

Diagnosis is Portal Hypertension, Esophageal Variceal bleed, Hyper-splenism, Ascites, GallStones Treatment: Resuscitations with fluid & blood product. Gastroscopy to look for underlying cause and offer endotherapy simultaneously.

blood transfusion correction of blood loss liver tonics check for all the necessary investigations then post for cholecystectomy

Post for removal of GB stone.

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