A chronic Alcoholic male aged 54 yrs presented with complaints of Malaena (on/off), abdominal distension, decreased urine output since 15 days and Altered Sensorium since 1 day.... He was found to be in Shock at presentation and was put on intropic support... comment on his condition and treatment approach to this patient...

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Decompensated chronic liver disease with alcoholic hepatitis ascites gi bleed sepsis. Shock with encephalopathy acute kidney injury with raised urea and hyponatremia may go into hrs Hypersplenism with thrombocytopenia noted Start broad spectrum antibiotics terlipressin Inotropes as needed Endoscopy and endotherapy Iv albumin Lactulose rifaximin Multivitamin include thiamine b12 Guarded prognosis

What are the signs of Decompensation in this case? Is it Hepatorenal syndrome?
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Alcoholic hepatitis with chronic liver disease with upper G.I blood- most likely from esophageal varices with septicemia with Ascitis with shock with hypersplenism. thrombocytopenia , hepatic encephalopathy and acute renal injury. Start IV line. , Parenteral antibiotics Piperacillin 4 GM + tazobactum 500 mg B.D. , RT feeding, rifaximin 400 mg ×8 hourly, lactulose 3tsf × 4 hourly , thiamine, An endoscopy and banding of esophageal varices. A dopamine drip to ensure adequate urine output and maintain B.P and correct hyponatremia

Alcohol related CLD with portal hypertension decompensated with ascites, jaundice, coagulopathy and GI bleed with high MELD score ...Needs urgent Endoscopy and variceal screening sos Banding...Continue antiencephalopathy treatment with Antibiotics ,lactulose and Hepato-pulmonary email drugs...Might need liver transplant

Malena - Because of oesophageal varices, gastric ulcer, gastritis , colitis please do OGD Scopy and colonoscopy Abdominal distention - because of ascites, may be having spontaneous bacterial peritonitis USG abdomen to confirm ascites and followed by ascitic fluid tapping, send for routine microscopy, culture in blood culture bottle Absolute neutrophil count of more than 250 in ascitic fluid is suggestive of spontaneous bacterial peritonitis Decreased urine output Please do serum creatinine, look out for hepatorenal syndrome Albumin infusion and terlipressine injection may help in treating hepatorenal syndrome Altered sensorium - please send serum ammonia to confirm hepatic encephalopathy Hepamerz (L ornithine L Aspartate) may help in treating hepatic encephalopathy Shock - use ionotropic support for treatment of shock Monitor urine output Send aerobic and anaerobic blood culture Use appropriate antibiotics for treatment of sepsis

Cirrhosis of Liver with hepatic failure with Hepatic encephalopathy.Altered sensoriim is 2ndary to hepatic encephalopathy. Suggest EEg, Arterial ammonia. Start hepatic encephalopathy regimen as per protocol

Chronic alcoholic cirrhosis of liver. Megaloblatic pictures with throbocytopenia with anaemia which is of multiple aeiology.. Poor diet deficit in bit. B12 / blood loss fromvarices.

Chronic alcoholic cirrhosis liver , megaloblastic picture with thrombocytopenia with anaemia which is of multiple aetiology -- poor diet / diet deficit in vit B12/ blood loss from varices Serum glucose LFT RfT arterial ammonia serum electrolyte USG abdomen Endoscopy UGI and ligation of bleeders Strict abstinence Diuretics for ascites Inj L ornithine aspartate Lactulose 30ml tds Ursocol

CLD From the picture details above , the patient is in hepatic encephalopathy. He is having a multiple problems with deranged KFT, LFT, coagulation profile and thrombocytopenia and anaemia. Put him on treatment protocol for ALD

Congratulations! Your case has been selected as Case of the day and you have been awarded 5 points for sharing the case. Keep posting your interesting cases, Happy Curofying!

It is a case of Chronic alcoholic Cirrhosis with Acute Hepatic failure , Coagulopathy & infection as WBC& other cell count distubance ,Impending coma.Very poor prognosis because of Multy system falure ,& on ionic support .

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