We should treat it on lines of Ascending Cholangitis with broad spectrum antibiotics along with biliary drainage. If d biliary stent which is visible on d CT images is ineffective, then d patient may require percutaneous drainage.
Hepatomegaly with gross central and peripheral IHBR dilatation... I think patiebt had obstructive jaundice with features of cholangitis, so Stenting has been done as seen in CT with minimal pneumobilia...
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SARCOIDOSIS. Sarcoidosis is a multi system inflammatory disorder of unknown etiology that predominantly affects the lungs and intra thoracic lymph nodes. Sarcoidosis is manifested by the presence of non caseating granulomas ( NCG's ) in affected organs. It is characterised by a seemingly exaggerated immune response against a difficult - to - discern antigen. SIGNS AND SYMPTOMS. The presentation of sarcoidosis depends on the extent and severity of organ involvement. *Asymptomatic. *Systematic complaints like fever and anorexia. *PULMONARY MANIFESTATION Dyspnea on exertion. Cough. Chest pain Hemoptysis. Pulmonary findings on physical examination can be Usually normal. Crepitus. External oxygen desaturation. LOFGREN SYNDROME. Fever,bilateral hilarious lymphadenopathy and polyarthralgias. DERMATOLOGICAL MANIFESTATION. *-Erythema nodosum. *A lower extremity panniculitis with painful erythematous nodules. *Lupus permit ( the most specific associated cutaneous lesion ) *Violaceous rash on cheeks and nose ( common ) *Maculopapular plaques ( uncommon ) OCULAR MANIFESTATION. *Anterior or posterior granulomatous uveitis. *Conjunctival lesions and scleral plaques. If untreated can lead to blindness. OTHER POSSIBLE MANIFESTATION. *Osseous involvement. *Heart failure from cardiomyopathy. *Heart block and sudden death. *Lymphocytic meningitis. *Cranial nerve palsies and hypothalamic / pituitary dysfunction. DIAGNOSIS. *Chest X-RAY central to the evaluation. *High resolution CT identifies active alveolitis versus fibrosis. *Gallium scans. *Pulmonary function tests and carbon monoxide diffusion capacity test of the lungs( DLCO ) for carbon monoxide is used routinely in evaluation and follow up. An isolated decrease in DLCO is the most common abnormality. *Cardiopulmonary exercise testing is a sensitive test for identifying and quantifying the extent of pulmonary involvement.I t also suggests cardiac involvement that otherwise is not evident. IMPAIRED HEART RATE RECOVERY DURING THE FIRST MINUTE FOLLOWING EXERCISE HAS BEEN SHOWN TO BE AN INDEPENDENT PREDICTOR FOR CARDIOVASCULAR AND ALL CAUSE MORTALITY. DIAGNOSIS REQUIRES BIOPSY IN MOST CASES.ENDOBRONCHIAL BIOPSY VIA BRONCHOSCOPY IS OFTEN DONE.THE CENTRAL HISTOLOGICAL FINDING IS THE PRESENCE OF NON CASEATING GRANULOMAS WITH SPECIAL STAINS NEGATIVE FOR FUNGUS AND MYCOBACTERIA. *Hypercalcemia. *Hypercalcuria. *Elevated alkaline phosphatase level. *Elevated angiotensin converting enzyme level. STAGING OF SARCOIDOSIS. STAGE O : Normal chest radiographic findings. STAGE I. : Bilateral hilar lymphadenopathy. STAGE II : Bilateral hilar lymphadenopathy and infiltrates. STAGE III : Infiltrates alone. STAGE IV : fibrosis. TREATMENT. Most patients do not require therapy and their condition improves spontaneously. Markers for poor prognosis are Advanced chest radiography stage. Extra pulmonary disease Evidence of pulmonary hypertension. Most patients require symptomatic treatment with NSAID 's for treatment of arthralgias. Treatment for patients with pulmonary involvement. *Asymptomatic patients do not require treatment. *In patients with minimal symptoms,serial re evaluation is prudent *Treatment is indicated for patients with severe symptoms. *Corticosteroid are helpful. *For extra pulmonary sarcoidosis involving heart,liver,eyes,kidney and central nervous system , corticosteroid therapy is indicated. *Topical steroids are useful for ocular disease. Common indications for non - corticosteroid are *Steroid resistant disease. *Intolerable adverse effects of steroids. Non corticosteroid agents are METHOTREXATE CHLOROQUINE and HYDROCHLOROQUINE used for cutaneous lesion,hypercalcemia,neurologic sarcoidosis and bone lesions. CHLOROQUINE is useful for Acute and maintenance treatment of chronic pulmonary sarcoidosis. CYCLOPHOSPHAMIDE is used in refractory sarcoidosis. AZATHIOPRINE is best used as a steroid sparing agent. CHLORAMBUCIL is beneficial in patients with progressive disease unresponsive to steroids. CYCLOSPORINE is of limited benefit in skin sarcoidosis or in progressive sarcoidosis resistant to conventional therapy. INFLIXIMAB & THALIDOMIDE are used for refractory sarcoidosis. FOR PATIENTS WITH ADVANCED PULMONARY FIBROSIS FROM SARCOIDOSIS,LUNG TRANSPLANTATION REMAINS THE ONLY HOPE FOR LONG TERM SURVIVAL. LONG TERM MONITORING. *Monitor pulmonary function and chest radiography every 6 months. *Assess for progression or resolution. *Determine if previously uninvolved organs have become affected. *Annual slit lamp examination and ECG are recommended.Dr. Suvarchala Pratap18 Likes18 Answers
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7 running month of pregnant lady having severe itching all over body, no any rashes . no response to steroid and antiallergic drugs. what to do ?Dr. Pramod Patel3 Likes16 Answers
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A male patient 48 years old, a chronic alcoholic presenting with icterus and malaise. What should be the management plan as the patient seems to have conjugated hyperbilirubinemia due to intrahepatic cholestasis?Dr. Lohitaksh Makasare3 Likes13 Answers
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A 25 year old male presented with jaundice, clay coloured stools and pruritis. bilirubin was 6 gm%, ALP wad 500 IU/l. biopsy from the biliary tract revealed the following. what is your diagnosis? a. Primary sclerosing cholangitis b Primary biliary cirrhosis c bile duct stones d secondary biliary cirrhosisDr. Ila Jain3 Likes12 Answers
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Hi every one Today we discuss about Liver.... The liver is a large, meaty organ that sits on the right side of the belly. Weighing about 3 pounds, the liver is reddish-brown in color and feels rubbery to the touch. Normally you can't feel the liver, because it's protected by the rib cage. The liver has two large sections, called the right and the left lobes. The gallbladder sits under the liver, along with parts of the pancreas and intestines. The liver and these organs work together to digest, absorb, and process food. The liver's main job is to filter the blood coming from the digestive tract, before passing it to the rest of the body. The liver also detoxifies chemicals and metabolizes drugs. As it does so, the liver secretes bile that ends up back in the intestines. The liver also makes proteins important for blood clotting and other functions. Liver Conditions Hepatitis: Inflammation of the liver, usually caused by viruses like hepatitis A, B, and C. Hepatitis can have non-infectious causes too, including heavy drinking, drugs, allergic reactions, or obesity. Cirrhosis: Long-term damage to the liver from any cause can lead to permanent scarring, called cirrhosis. The liver then becomes unable to function well. Liver cancer: The most common type of liver cancer, hepatocellular carcinoma, almost always occurs after cirrhosis is present. Liver failure: Liver failure has many causes including infection, genetic diseases, and excessive alcohol. Ascites: As cirrhosis results, the liver leaks fluid (ascites) into the belly, which becomes distended and heavy. Gallstones: If a gallstone becomes stuck in the bile duct draining the liver, hepatitis and bile duct infection (cholangitis) can result. Hemochromatosis: Hemochromatosis allows iron to deposit in the liver, damaging it. The iron also deposits throughout the body, causing multiple other health problems. Primary sclerosing cholangitis: A rare disease with unknown causes, primary sclerosing cholangitis causes inflammation and scarring in the bile ducts in the liver. Primary biliary cirrhosis: In this rare disorder, an unclear process slowly destroys the bile ducts in the liver. Permanent liver scarring (cirrhosis) eventually develops. Liver Tests Blood Tests: Liver function panel: A liver function panel checks how well the liver is working and consists of many different blood tests. ALT (Alanine Aminotransferase): An elevated ALT helps identify liver disease or damage from any number of causes, including hepatitis. AST (Aspartate Aminotransferase): Along with an elevated ALT, the AST checks for liver damage. Alkaline phosphatase: Alkaline phosphatase is present in bile-secreting cells in the liver; it's also in bones. High levels often mean bile flow out of the liver is blocked. Bilirubin: High bilirubin levels suggest a problem with the liver. Albumin: As part of total protein levels, albumin helps determine how well the liver is working. Ammonia: Ammonia levels in the blood rise when the liver is not functioning properly. Hepatitis A tests: If hepatitis A is suspected, the doctor will test liver function as well as antibodies to detect the hepatitis A virus. Hepatitis B tests: Your doctor can test antibody levels to determine if you have been infected with the hepatitis B virus. Hepatitis C tests: In addition to checking liver function, blood tests can determine if you have been infected with the hepatitis C virus. Prothrombin Time (PT): A prothrombin time, or PT, is commonly done to see if someone is taking the correct dose of the blood thinner warfarin (Coumadin). It also checks for blood clotting problems. Partial Thromboplastin Time (PTT): A PTT is done to check for blood clotting problems. Imaging Tests: Ultrasound: An abdominal ultrasound can test for many liver conditions, including cancer, cirrhosis, or problems from gallstones. CT scan (computed tomography): A CT scan of the abdomen gives detailed pictures of the liver and other abdominal organs. Thank you all hope u enjoy the reading Tomarow I will come with the treatment of different liver diseases ... So join again with me tomarow Till than have a good time and a healthy life Regards Dr BakshiDr. Kousar Bakshi15 Likes12 Answers