ALCOHOLIC HEPATITIS. Chief Complaints A 54 YR OLD MALE ATTENDED EMERGENCY WITH PAIN IN LOWER ABDOMEN SINCE 28 DAYS WITH MULTIPLE EPISODES OF STOOL AND NAUSEA. NO ASSOCIATED VOMITING,URINE OR STOOL DISCOLOURATION,PRURITUS,TREMOR,FEVER,BLOODY VOMITUS,BLACK COLOURED STOOL ETC. HE IS K/C/O HTN, T2DM. CHRONIC ALCOHOLIC SINCE 25 YRS. PT IS HAVING BINGE ALCOHOL INTAKE FOR PAST FEW MONTHS. GENERAL EXAMINATION NORMAL. SYSTEMIC EXAMINATION NORMAL EXCEPT P/A - DISTENDED ABDOMEN WITH NO FLUID THRILL OR SHIFTING DULLNESS. UMBLICUS NORMAL SHAPE AND LOCATION. PT WAS ADMITTED AND ROUTINE IX WAS ADVISED. REPORTS SHOWS- RAISED SGPT 82 SGOT 216 WITH AST:ALT RATIO MORE THAN 2.5. LOW SR ALBUMIN SINCE BEING NEGATIVE ACUTE PHASE REACTANT. VIRAL PROFILE NEGATIVE. REST BLOOD REPORTS NORMAL. USG WA- HEPATOMEGALY WITH SEVERE FATTY CHANGES, MOD ASCITES AND INFLAMMMED AND ECHOGENIC MESENTRY IN RIF.NORMAL PORTAL VEIN DIAMETER. CECT ABDOMEN- BPH.B/L INGUINAL HERNIA, HEPATOMEGALY WITH DIFFUSE INFILTRATION PT WAS MANAGED CONSERVATIVELY AND BEING DISCHARGED IN STABLE CONDITION AND PUT UNDER FOLLOW UP. LFT REPORTS ARE SUGGESTIVE OF ALCOHOLIC LIVER DISEASE WITHOUT FEATURES OF CIRRHOSIS ( ALCOHOLIC HEPATITIS). NOTE - ASCITES CAN BE SEEN IN ALD WITHOUT PORTAL HYPERTENSION. AST:ALT RATIO > 2:1 POINTS TOWARD ALD.

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Pentixifilin ( trental )

MDF score 4.6 x( pt - control pt) + s.creatine if less than 32 give pentocifillin if more than 32 corticosteroid alsong with insulin . If pt is deranged give vit k. If no improvement bad prognosis.

>32, give steroid, if contraindicated give pentoxifylline
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How is RFT??Subacute Bacterial Peritonitis to be rule out by Ascites Fluid

Withdraw alcohol Tab udiliv 300mg BD.. 7-10DAYS HEPATOTROPIC vit. and methylcobalaminde VitE 600mg oD Include white of egg in diet if can

Single dose of Ars alb with dietary management

Can we add Tab Liv 52 & Liq Duphalac ?

Lower abdomen pain was due to ? Cystitis , or hernia or ge .. Urine routine and microscopy could have been done .. Advice to consult urologist for prostatomegaly ..evaluate for post void residual urine .. Later to surgeon for hernia repair .. Advice to stop drinking

Inj metrogyl 100 ml tds Inj tazar4. 5 gm bd Inj oflox 750 mg of Inj pantop 40 mg of Inj Ondaesteron 4 mg bd Inj dtvn 1 amp bd Tab Ursotina 300 mg bd Sachet urikind km od Sachet hepamerz od Watch vitals bp hr and input output strictly then Tab dytor plus 5 mg od tab librium 5 mg hs

No requirement of oflox. pipzo and metrogyl would suffice.
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K/C/O :- HTN/T2DM/CHRONIC ALCOHOLIC SINCE 25 YEARS WITH MANY EPISODES OF STOOL & NAUSEA ASSOCIATED WITH LOWER ABDOMINAL PAIN RAISED LIVER TRANSAMINASE LEVELS & RATIO IS MORE THAN 2.5. VIRAL MARKERS ARE NEGATIVE. USG SHOWED HEPATOMEGALY WITH SEVERE FATTY CHANGES, MODERATE ASCITIS WITH INFLAMMED & ECHOGENIC MESENTRY IN RIF. CECT WHOLE ABDOMEN SHOWED BPH WITH INGUINAL HERNIA WITH HEPATOMEGALY WITH DIFFUSE INFILTRATION. IMPORTANT POINT IS, ASCITIS CAN BE SEEN IN ALCOHOLIC LIVER DISEASE WITHOUT PHTN. AST:ALT RATIO >2:1 WHICH POINTS TOWARD ALD.

Nux Vom, Hydrastis,Q Homoeo,

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