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...



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

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

Upper gi bleed with hepatic encephalopathy with shock. Rule out SBP.. Medical optimization in ICU. PRBC as per need. Keep Hb at 7 to 8 GM. Iv Terlipressin. Iv Albumin. Iv Antibiotics..PPI.. Vit K.. Lactulose enemas. Venti support sos. Routine Labs. NH3. Triple H. AFP.. Ecg. Xray chest..USG. Early EGD Scopy. Diagnostic ascitic tap sos.

Cirrhosis with Bleeding from PHG more likely than variceal bleed in view of 15 day history.

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

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

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 .

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.

HepatoRenal syndrome with sepsis . Neomycin oral or Pre, probiotics, enema , maintenance of fluid and electrolyte balance.. prognosis very moriband.

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