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...

34yr /m. Alcoholic. C/0 abdominal pain and mild distension. Most likely diagnosis?

FATTY LIVER Nonalcoholic fatty liver disease is an umbrella term for a range of liver conditions affecting people who drink little to no alcohol. As the name implies, the main characteristic of nonalcoholic fatty liver disease is too much fat stored in liver cells. Nonalcoholic steatohepatitis, a potentially serious form of the disease, is marked by liver inflammation, which may progress to scarring and irreversible damage. This damage is similar to the damage caused by heavy alcohol use. At its most severe, nonalcoholic steatohepatitis can progress to cirrhosis and liver failure Nonalcoholic fatty liver disease is increasingly common around the world, especially in Western nations. In the United States, it is the most common form of chronic liver disease, affecting an estimated 80 to 100 million people. Nonalcoholic fatty liver disease occurs in every age group but especially in people in their 40s and 50s who are at high risk of heart disease because of such risk factors as obesity and type 2 diabetes. The condition is also closely linked to metabolic syndrome, which is a cluster of abnormalities including increased abdominal fat, poor ability to use the hormone insulin, high blood pressure and high blood levels of triglycerides, a type of fat. Causes Experts don't know exactly why some people accumulate fat in the liver while others do not. Similarly, there is limited understanding of why some fatty livers develop inflammation that progresses to cirrhosis. Nonalcoholic fatty liver disease and nonalcoholic steatohepatitis are both linked to the following: · Overweight or obesity · Insulin resistance, in which your cells don't take up sugar in response to the hormone insulin · High blood sugar (hyperglycemia), indicating prediabetes or actual type 2 diabetes · High levels of fats, particularly triglycerides, in the blood These combined health problems appear to promote the deposit of fat in the liver. For some people, this excess fat acts as a toxin to liver cells, causing liver inflammation and nonalcoholic steatohepatitis, which may lead to a buildup of scar tissue (fibrosis) in the liver. Symptoms Nonalcoholic fatty liver disease usually causes no signs and symptoms. When it does, they may include: · Enlarged liver · Fatigue · Pain in the upper right abdomen Possible signs and symptoms of nonalcoholic steatohepatitis and cirrhosis (advanced scarring) include: · Abdominal swelling (ascites) · Enlarged blood vessels just beneath the skin's surface · Enlarged breasts in men · Enlarged spleen · Red palms · Yellowing of the skin and eyes (jaundice) Risk factors A wide range of diseases and conditions can increase your risk of nonalcoholic fatty liver disease, including: · High cholesterol · High levels of triglycerides in the blood · Metabolic syndrome · Obesity, particularly when fat is concentrated in the abdomen · Polycystic ovary syndrome · Sleep apnea · Type 2 diabetes · Underactive thyroid (hypothyroidism) · Underactive pituitary gland (hypopituitarism) Nonalcoholic steatohepatitis is more likely in these groups: · Older people · People with diabetes · People with body fat concentrated in the abdomen It is difficult to distinguish nonalcoholic fatty liver disease from nonalcoholic steatohepatitis without further testing. Complications The main complication of nonalcoholic fatty liver disease and nonalcoholic steatohepatitis is cirrhosis, which is late-stage scarring (fibrosis) in the liver. Cirrhosis occurs in response to liver injury, such as the inflammation in nonalcoholic steatohepatitis. As the liver tries to halt inflammation, it produces areas of scarring (fibrosis). With continued inflammation, fibrosis spreads to take up more and more liver tissue. If the process isn't interrupted, cirrhosis can lead to: · Fluid buildup in the abdomen (ascites) · Swelling of veins in your esophagus (esophageal varices), which can rupture and bleed · Confusion, drowsiness and slurred speech (hepatic encephalopathy) · Liver cancer · End-stage liver failure, which means the liver has stopped functioning About 20 percent of people with nonalcoholic steatohepatitis will progress to cirrhosis. HOMOEOPATHIC REMEDIES Homoeopathic remedies are safe remedies for the treatment of fatty liver. Some of the important remedies are given below-- CHELIDONIUM Q- Chelidonium is the top Homeopathic medicine for Fatty Liver treatment. The marked symptom for using this medicine is pain in right upper abdomen and pain under right shoulder. There may also be an enlargement of liver.The person is usually constipated. The stool passes in the form of hard balls. A distended abdomen with nausea and vomiting is also experienced. The patient suffers from excessive weakness. In case of jaundice in a patient with Fatty Liver too, Chelidonium is the best Homeopathic remedy. Desire for very hot drinks and hot food CARDUS MARIANUS Q—.Pain in the liver region . Left lobe is very sensitive. Fullness and soreness with moist skin. Constipation. Stool hard, difficul and knotty. Alternates with diarrhea. Golden colored urine Nausea, vomiting of green acid fluid BOLDO Q- Congestion of liver . Burning weight in liver and stomach. Bitter taste , no appetite LYCOPODIUM CLAVATUM 200- Lycopodium is another remedy of great help for treating Fatty Liver with gastric symptoms and acidity. The patient complains of distension or bloating of abdomen soon after eating anything. The abdomen feels full of gas. Burning belching is also experienced. Even eating a little causes fullness in abdomen. The patient feels heaviness and pain in the right upper part of abdomen. Usually the symptoms get worse towards the evening. Farinaceous food makes the person worse. An unusual craving for sweets and hot drinks in excess may be present. PHOSPHOROUS 200-Phosphorus is the best Homeopathic medicine for patients of Fatty Liver who feel as if the food is coming upwards after eating. This is accompanied by sour belching. Vomiting may also occur in a few cases, along with pain in liver. The stool and flatus are very offensive. The patient feels weak after passing stool. The craving for peculiar things in diet is an important indication for using this medicine in Fatty Liver patients. These peculiar things include ice creams, cold drinks and refreshing items like juices. CALCAREA CARB 30- Calcarea Carb is a very beneficial Homeopathic medicine for mainly obese Fatty Liver patients. The person is fatty, flabby with excess fat in liver and whole abdomen. This Homeopathic remedy successfully helps in burning excess fat in liver.The digestion is very slow in such persons with a long-standing constipation. The abdomen always remains distended. Milk is not suitable for these persons. Desire for boiled eggs or strange things like chalk and pencils. Sensitivity to cold air and excessive sweating on the head. NUX VOMICA 30- Nux Vomica is the best fatty liver remedy in homeopathy when the cause is over consumption of Alcohol . It is prescribed when pain in abdomen begins a few hours after eating, with a feeling of stone in abdomen. Sour or bitter belching accompanies the pain. A very significant symptom for selecting Homeopathic remedy Nux Vomica for Fatty Liver is constipation with an ineffectual urge to pass stool or poop. The stool, however, is insufficient and unsatisfactory. The passing out of stool gives some relief from the pain in abdomen but the urge to pass stool is renewed soon after. The patient craves for fattyfood, spicy food, coffee and alcoholic drinks in diet.

60 years old k/c/o t-2 DM diagnosed 3 years back not taking Any medications , presented with fever sob generalised weakness , icterus, polyuria since 3 days f/b no urination since 1 day BP 100/60 hr 130 spo2 99% with room air , Cool peripherals , GRBS 450mgdl. D/d before investigations ? S cret 2 mg/dl b urea 64 , toltal bilirubin 8.9 direct 6 .

Friends today I am discussing about Gall bladder stones. Gallstones The gallbladder stores and releases bile which helps digest fats. Sometimes gallstones form in the gallbladder or bile ducts. Gallstones may cause pain. Treatment options include medication or surgical removal of the stones or the gallbladder itself. What are gallstones? Gallstones are stone-like objects that form in the gallbladder or bile ducts. Gallstones can be tiny (the size of a grain of sand), or may be as large as a golf ball. Depending on the symptoms, people who have gallstones may not need treatment, or they may need to take medication or have surgery to remove their gallbladder. If the stones are in the bile ducts, they usually need to be removed by endoscopy. What is the gallbladder? The gallbladder is an organ that resembles a small pear. It is located under the liver on the right side of the abdomen. The function of the gallbladder is to store and dispense bile, a fluid that is produced by the liver and helps digest fats in the foods you eat. Bile is made up of several substances, including bilirubin and cholesterol. The gallbladder is connected to the liver and the intestine by a group of ducts, including the hepatic duct, the cystic duct, and the common bile duct. When you eat, the gallbladder sends bile through the common bile duct into the intestine to help you digest food, particularly fatty foods. Who is at risk for gallstones? The following have an increased risk for developing gallstones: Women. People over the age of 40. People who have a family history of gallstones (relatives who have the disease). People who are overweight or obese. People who lose a great deal of weight in a short period of time. People who have diabetes. People with Crohn’s disease. People whose diet is high in fat and cholesterol. People who take drugs that lower cholesterol. How do gallstones form? There are 2 types of gallstones: pigment stones (made up of bilirubin) and cholesterol stones (made up of cholesterol). Most gallstones are cholesterol stones. Cholesterol gallstones can form when there is too much cholesterol or bilirubin in the bile. Gallstones can also develop if the gallbladder does not completely empty itself of bile. Pigment gallstones may form in people who have certain conditions, such as cirrhosis of the liver or blood disorders. What are the symptoms of gallstones? In many cases, people who have gallstones do not have any symptoms. These gallstones are known as "silent stones." The main symptom of gallstones is pain, which can last from several minutes to several hours. Pain can occur when gallstones move from the gallbladder into one of the ducts (the hepatic duct, the cystic duct, and the common bile duct). Gallstones that migrate can cause conditions such as acute cholecystitis(inflammation of the gallbladder), cholangitis (infection and inflammation of the bile ducts), and pancreatitis(inflammation of the pancreas). The pain may be located in the upper part of the abdomen, between the shoulder blades, or under the right shoulder. Other symptoms of gallstones include: Sweating Vomiting Fever A yellow tint to the skin (jaundice) Homeopathic medicines used for treating gall stones Calcarea carbonica: If you have a family history of kidney and gall stones, are anxious and slow, overweight with high deposits of triglycerides and cholesterol, then you would be given this medicine. Chelidonium: If you get pain in any or both of the two patterns pain originating under your right shoulder blade and pain in the upper right abdomen, which spreads to the back, you will be prescribed this one. Lycopodium: This medicine is usually recommended in case you have a family history of stones in kidney and gall bladder, along with other complications like, chronic digestive disorders, high cholesterol, gastric problems, constipation, peptic ulcers, gas and bloating. The patient may usually get biliary colic pains late in the afternoon. He or she may also get irritated easily, and hate contradicting opinions. Natrum sulphuricum: The patient may have any or some of the problems like chronic diarrhea, gall stone pain, asthma, chronic obstructive pulmonary disease, depression, obesity and problem in joints. On top of that the patient may be too sensitive to changes in humidity and weather. In such a case, Natrum sulphuricum is given. Nux vomica: If a patient suffers from nausea, colic pains, spasmodic pains, heartburn and acidity, gas and bloating, and takes too much of rich and oily food and drinks, then this medicine is used to treat gall stones for him or her.