58yr old woman presented with constipation since 1 month, abdominal pain since 15days and distention since 4 days. Previous history of hematemesis 11 years back for whish she was treated. -Has hypertension since past 8 years and takes medication irregularly. -Examination shows distention of abdomen, tenderness in right hypochondrium, enlarged spleen -USG reveals hydro uretero nephrosis, enlarged spleen (13cm) and shrunken liver. What would be the diagnosis and treatment?

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1 HTN 2 HEMATEMESIS 11 YR BACK POSSIBLY DUE TO P U S 3 CIRRHOCIS OF LIVER WITH ASCITES & PORTAL HTN 4 HYDROURETERO NEPHROSIS ( ONE ONE OR BOTH SIDES ? ) SUGGESTS OBSTRUCTIVE UROPATHY 5 HEMATEMESIS MAY FROM OESOPHAGEAL VARICES OR NON VARICEAL PEPTIC ULCER BLEED 6 PAIN ABD MAY BE DUE TO CONSTIPATION OR BSTRUCTIVE UROPATHY RX a FLUID RESTN. TO 1 L /DAY SALT 6gm/ day b PROTEIN NORMAL INTAKE TILL ENCEPHALOPATHY c PPI d PROPRANOLOL e ALDOSTERONE F + / - DIURETIC g BANDING OF GRADE 3 / 4 VARIC ES .IF FOUND h UROLOGICAL CONSULTATION I DUPHALAC ÙGI ENDOSCOPY BLOOD LFT @@ HBsAg, HCV AB CREATININE EGFR URINE ROUTINE C & S ...

Budd chiari syndrome induced CIRRHOSIS WITH PORTAL HYPERTENSION ?? Other DDs: Alcoholic liver disease Non Cirrhotic Portal hypertension

Cirrhosis of Liver with portal hypertension with ? Oesophagial varices.

Decompensated cirrhosis of liver with splenomegaly, ascites and Rt Ureteric obstruction with HDN Cause of Rt.HDN has to be identified. Will need RFT, CT KUB with contrast depending on RFT results and treatment accordingly

Hepatic cirrhosis with rt sided hydroureteronephrosis advice kft lft urine re c/s upper go endoscopy and evl if required Paracentesis may be advised if vitals are stable if serum albumin low give iv albumin If ascitic fluid transudative and bp stable add beta blockers and give bowel regulators ( laxatives)lactulose

Ascites with portal hypertension Do viral markers to R/o disease Update ascitis fluid examination report Give proctolysis enema tid Do UPGI ENDOSCOPY to R/o ulcer???

complication from cirrhosis... alcoholic history to be asked.. syrup lactulose 4 tsf HS...

Patient said that she does not drink alcohol
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Pt might have had NAFLD and maybe a consequence of that or maybe even autoimmune in nature Update on the previous history of hemetemesis

Liver cirrhosis

Cirrhosis with portal htn

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