four years male present with anasarca bilateral pitting oedema fluid thrill and shifting dullness positive umbilicus everted periorbital puffiness icterus positive hepatosplenomegaly with attached report. rk 39 and Australia antigen is negative. usg report suggestive of ascites and there possibility of autoimmune hepatitis because SGPT IS NOT MUCH ELEVSTED IN COMPARISION TO SERUM BILIRUBIN ELEVATION. HISTORY of blood TRANFUSION one time. history of casualty of sister three months ago. sister suffering from same problem according to patient father. father is migrant worker. chest X-RAYS suggestive of cardiomegaly. further investigation and treatment.



DD- Autoimmune hepatitis Wilson's disease Alpha 1 antitrypsin deficiency Primary sclerosing cholangitis Chronic hepatitis C Glycogen storage diseases Indian childhood Cirrhosis PEM with kwashiorkor

Wilson. Please check serum ceruloplasmin level 24 hour copper excretion in urine. Ophthalmology exam slit lamp for KF rings. In view of sibling death due to same problem wilson is highly possible. Other causes like storage disorders is another possibility. Autoimmune hepatitis occurring in sibling s is rare.

Cirrhosis of liver as portal hypertension with hepatic necrosis. Viral markers, ,Wilson disease, Macrocytic anaemia

Pt is having liver failure with high bilirubin' and low SGPT she can land in hepatic crisis anytime .now as per etiology Wilson d is high on card .now autoimmune hepatitis do ANA ,dsDNA ,LKM , .

rule out dubin Johnson syndrome gilbert syndrome

Dubin Johnson and Gilbert syndrome are benign conditions which needs no treatment

Wilson's ds can present in childhood as well as middle age. Usually presentation is after 5 years ..but it can present even before that Familial picture suggests some genetic conditions like Wilson's But need to rule out congenital hyperbilirubinemias

Chronic liver disease. Metabolic or autoimmune. Esr high ,anemia, thrombocytopenia, leucocytosis.Further work up on the lines of cld.

I agree with Dr. Abdul Salam

R/o autoimmune hepatitis/ CLD Wilson Hemolytic anemia

Kindly to cereluoplasmin levels as suggested.also work up for infectious causes like hepatitis,cytomegalovirus,Epsteins.if autoimmune is considered look for anti smooth muscle antibody,anti liver kidney microsomal antibody.also do routine monitoring of blood sugar and synthetic functions of liver

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