46 YEAR OLD WITH YELLOWISH DISCOLORATION OF EYES 


This is an online E log book to discuss our patient's de-identified health data shared after taking his/her/guardian's signed informed consent. Here we discuss our individual patient's problems through series of inputs from available global online community of experts with an aim to solve those patient's clinical problems with collective current best evidence based inputs. This E log book also reflects my patient-centered online learning portfolio and your valuable inputs on the comment box. 

This is case of 46 year old male who is a master cook by occupation came to opd with complaints of yellowish discoloration of eyes and urine since 3 months 

HOPI: patient was apparently normal 1 year back ,then he developed lower back ache ,diagnosed with renal calculi and was operated.

C/o fever since 3 months 
        Insidious in onset 
        Gradually progressive 
        Subsides on its own 
        More during nights

C/o nausea since 3 months

C/o vomitings ( 4 -5 episodes) food particles as content

H/o weight loss since 1month

C/o pain abdomen intermittently and was admitted in an hospital thrice till now and diagnosed with chronic pancreatitis

H/o usage of Herbal medicine 1 month back ,6 times/day for a week

H/o pedal edema and abdominal distension 1 month back , used medication for this in Nalgonda 

PAST HISTORY: 
He is a known case of alcoholic and tobacco chewers since 20 years 
H/o Renal caliculi and was operated for that .

PERSONAL HISTORY : 
Thin built 
Appetite lost 
Regular alcoholic and tobacco chewer,
stopped 3 months back 
Bowel movements are Regular

FAMILY HISTORY: Not significant

GENERAL EXAMINATION: 
ICTERUS present 
NO PALLOR, CYANOSIS,CLUBBING, LYMPHADENOPATHY,EDEMA
                        
                                                                                   



Patient is conscious, coherent, cooperative 
Temperature : 98.5°f 
BP: 80/60mmhg
PR: 99bpm 
RR: 18CPM 
SPO2: 99@room air
CVS:S1S2+ no murmurs 
RS: NVBS+ clear

PER ABDOMEN:

INSPECTION: scaphoid abdomen, umbilicus inverted,no engorged veins,no sinuses 
PALPATION:  LIVER PALPABLE ,No tenderness, no palpable mass .
PERCUSSION:Hepatomegaly + ,LIVER span 20cm.
AUSCULTATION: Bowel sounds +





CNS: NAD

INVESTIGATIONS:






DIAGNOSIS: ACUTE DECOMPENSATED LIVER DISEASE 

TREATMENT:
1. Inj.THIAMINE 2amp in 500ml NS/IV/TID over 2hrs 
2.INJ.PANTOP 40MG/IV/OD 
3.INJ.ZOFER 4MG/IV/BD
4.INJ.OPTINEURON 1amp in 100ml NS /IV/OD 
5.INJ.VIT.K 1amp/IV/OD 
6.INJ.MEROPENUM 1GM /IV/BD
7.TAB.DOILIN 300MG /PO/BD 
8.TAB.RIFAGUT 550MG /PO/BD
9.SYRUP .LACTULOSE 10ML /PO/OD
10.SOAP WATER ENEMA 
11.ABDOMINAL GIRTH MEASUREMENT
12. FEVER CHARTING 
13.MONITOR VITALS

DAY 2
S : 
No fever spikes 
No fresh complaints 

O : 
Pt is C/C/C 
Temp : afebrile
BP : 110/50
PR : 74 bpm
RR : 20 cpm 
CVS : s1 s2 heard, no murmurs 
RS : NVBD + , No crepts
PA : Soft, hepatomegealy + , 22 cm liver span
        No engorged veins/ distension
GRBS : 284 mg/dl 

A : 
ACUTE DECOMPENSATED LIVER DISEASE WITH CONJUGATED HYPERBILIRUBINEMIA 

P : 
1. INJ.  MEROPENEM 1 GM/IV/BD ( D3 )
2. INJ.  PANTOP 40 MG /IV/ OD
3. INJ.  ZOFER 4 MG /IV/SOS
4. INJ.  THIAMINE 2 AMP IN 500 ML NS /IV/TID
5. INJ.  OPTINEURON 1 AMP IN 100 ML NS /IV OD

    APRAXIA CHARTING  



DAY 3
S : 
No fever spikes 
No fresh complaints 

O : 
Pt is C/C/C 
Temp : Afebrile
BP : 100/50
PR : 80 bpm
RR : 17  cpm 
CVS : S1,S2 heard, no murmurs 
RS : NVBD + , No crepts
PA : Soft, hepatomegealy + , 22 cm liver span   
No engorged veins/ distension
GRBS : 302mg/dl 
FBS: 391mg/dl
HBA1C :  7.3%

A : 
ACUTE DECOMPENSATED LIVER DISEASE WITH CONJUGATED HYPERBILIRUBINEMIA WITH ALCOHOLIC HEPATITIS WITH ALCOHOL INTRAHEPATIC CHOLANGITIS WITH DENOVO DM- II 

P : 
Gastroenterology opinion





DAY 4 

http://surigimounika.blogspot.com/2022/03/36-year-old-with-yellowish.html 

S : No fever spikes 
No fresh complaints 

O : 
Pt is C/C/C 
Temp : Afebrile
BP : 100/50
PR : 89bpm
RR : 18  cpm 
CVS : S1,S2 heard, no murmurs 
RS : NVBD + , No crepts
PA : Soft, hepatomegealy + , 22 cm liver span   
No engorged veins/ distension
GRBS : 184mg/dl 
HbA1c:  7.3%
Total bilirubin: 9.35mg/dl
Direct bilirubin:6.40mg/dl


A : 
ACUTE DECOMPENSATED LIVER DISEASE WITH CONJUGATED HYPERBILIRUBINEMIA WITH ALCOHOLIC HEPATITIS WITH ALCOHOL INTRAHEPATIC CHOLANGITIS WITH DENOVO DM- II 

P : 
Gastroenterology opinion done : advised endoscopy 

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