CLD pt in Hepatic Encephalopathy with Deep Abd Wound

A k/c/o CLD (Alcoholic) p/w Chief Complaints Altered Sensorium Irrelevant Talks Loss of Bladder n Bowel control (x 3 days) Vitals BP- 108/60 mmHg PR- 102/min Physical Examination GCS- E2V3M4 Neck Rigidity- Neg

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Kco CLD and pt is alcoholic Hence LFTS are needed which are likely deranged Pt has lost control on bowel and bladder and in hepatic encephalopathy GCS is critical Adv sr electrolytes and rest of bed side investigations Adv MRI brain And usg abdomen The wound is not fresh and appear septic hence cbc is important Is it stab wound or else R/o liver rupture Management will depend on stepwise

Thanx dr Rajendra Rai
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Hepatic Encephalopathy with cormodities with GCI is poor we have to go for viral marker & LFT with Blood sugar CECT of abdomen with MRI of brain For cirrohosis of liver & ascitis & any malignancy

Lot of thanks Dr. Rajinder Rai
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See for electrolyte N also see for ammonia See ecg n usg abdo pel See for ascitis tapping N also see for albumin N treat accordingly

Patient having non healing wound

Known case of alcoholic CLD with infected wound with Septicaemia leading to hepatic encephalopathy. There are other possibility to rule out hypoglycaemia ,electrolyte imbalance and septic meningitis. Suggested investigations-----जहां CBC,LFT,KFT,BIood- Sugar, S-Electrolyte, Urine-R & M , CSF-R&M,C&S,Blood- Ammonia, Ascites flluid- R&M,C&S ,X-RAY CHEST PA VIEW, USG -Whole abdomen n pelvis and CT- Head/ MRI - Brain. Also C& S from wound site .

Ascitis tapping Electrolytes correction Protein replacement judiciously

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