What's the treatment and management?

50Y / M . Suffering from abdominal discomfort since 15days and weakness feel. Chief Complaints Flatulence, mild pain in left side lower abdomen. Low back pain left side pelvic region. History Low back pain since 8 years ago, X-RAY and orthopedic suggest LIPING in left back pelvic region. Use L S belt , exercise, and medication when essential. Vitals BP 160/100 mm/ hg Puls 95 bpm. SpO2 97% Body weight 67kg. Physical Examination Smoker - 30years, bidi, cigarette, Tea adicted, anytime like tea. Alcohol regularly 90ml -180 ml. Appetite normal,like veg better than nonveg. Investigations Blood reports are below. Diagnosis Please suggest? Management Please suggest?

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Diabetic Raised liver enzymes ,? Alcoholic hepatitis. Viral hepatitis has to be ruled out. Serum creatinine high normal. DD 1) Lumbar disc prolapse with root compression and referred pain to anterior abdomen .. 2) Hepatitis, ? Alcoholic , ? Viral with alcoholic gastritis . 3) Left ureteric stone, need abdominal ultrasound confirmation. Treatment after diagnosis

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He is alcoholic and chr smoker Lfts suggest deranged enzymes So also lipid profile suggest dislipidimia Altogether a c/o fatty liver with deranged functions hence adv for usg abdomen Ppis antacids Digestive enzymes Hepatocellular regeneratives like hepamerz and vimliv Dietary restrictions Modified vegetarian diet salads etc Abstinence from addiction

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*In this case,Blood test reveals some problems(viral markers needed)but radiological intervention can exposes more. DD: Alcoholic liver disease,Dyslipidemia,Chronic gastritis, Osteoporetic changes in Lumbar segment, Hypertension G-1 etc. Tx: 1.antiulcerant+antiflatulence 2.antispasmodic 3.statins 4.NSAIDS (GI friendly) 5.Ursodeoxycholic acid 6.Amitryptyline or BDZ 7.Ca channel blocker However need more evaluation.

Addiction should be restricted Diet should be veg or fibre enriched. Water: 2-3 L/day
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Adv USG abd and pelvis, sos CT abdomen and pelvis to rule out renal calculus or Infective focus if any.

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usg abdomen to rule out inguinal hernia ureteric stones managed conservatively

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Start with usg abdomen ,borderline raised lft can be due alcohol and repat ls spine cxray maybe Lower abdomen pain i.e groin can be due to renal stone Start initially with ppi,and. See the response Rest all management may depend on usg abdomen plus pelvis reports

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Early cirrhosis with gastritis .

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