case based discussion lap top 23 rd august 2015 lap top 23 rd august 2015

Download Case Based Discussion LAP TOP 23 rd August 2015 LAP TOP 23 rd August 2015

Post on 17-Jan-2016




0 download

Embed Size (px)


Case Based Discussion

Case Based Discussion LAP TOP 23rd August 2015Case- 1 4 year old girl childPresented with yellowish discoloration of eyes and urine x 4 daysH/o Prodrome of fever and vomitingNo H/o pedal edema, clay colored stool , itching , altered sensorium and bleedingDevelopmentally normal and Hepatitis B Vaccine given; Hepatitis A not givenDr Pradeep Kumar Sharma Dr Sanjay Sehta, Dr UtkarshExaminationLiver 5cm BCM, Span 11cm; Slight Tender; round Border ; smooth surfaceSpleen : Not palpableShifting Dullness +Bowel Sounds : NormalRest System :WNL

Clinical Impression4 year old child with prodromal symptoms and Jaundice ; Hepatomegaly with ascities S/o Hepatitis of Infective EtiologyAcute Viral Hepatitis MalariaDengueEnteric FeverClinically how to differentiate between the three ?4

USG Abdomen: Hepatomegaly with Hypoechoic Liver; Ascites ; and Minimal Rt Pleural Effusion760/1230Investigation Contd.PS for MP NegativeDengue /NS-1 NegativeTyphidot NegativeLeptospira NegativeHbsAg , Anti HCV and Anti HEV NegativeIg M Anti HAV PositiveLKM /SMA/ANA NegativeCeruloplasmin 35 mg/dl All Viral Markers required ?PT/INR must in all cases of AVH ?Ascites and Pleural Effusion in AVH ?Final DiagnosisAcute Viral Hepatitis (HAV related) with ascites and pleural effusion and anemia12345

Dietary Advice ?When to admit patient with Acute Viral Hepatitis ?IV Fluids ? Any Specific Medications ?Vitamin Supplements ? Liver Tonics ?Serial Monitoring of Liver Functions- When and What ? MANAGEMENTAnswers by expertsHigh Enzymes favor AVHAscites in 13% cases of AVHNormal Diet, no restrictionsAdmit if f/o Hepatic encephalopathy, Pt prolonged and Liver size decreasedNo specific medicines except UDCA in pruritiesPT/INR and Serological markers (HBsAg, Ig M Anti HAV , IgM Anti HEV)No serial monitoring required , LFT after 2-3 months to see for normalization

Case- 245 day boy, Normal Delivery; BW 3.5kgD0 D4 D10 D20 D30 D45Ante Natal UneventfulBreast FeedsTB 16D 1.2PhototherapyJaundice, Pigmented Stool and High Colored UrinePoor Wt Gain 10gm/dPoor feeding? Seizure at D 42Progressive Abdominal DistentionHIDA ExcretoryProf Mala Kumar, Dr Chavvi NandaDr Ashutosh Verma , Dr Salman KhanClinically Differentiate Between Intrahepatic and Extrahepatic Obstructive Jaundice ?Role OF USG AND HIDA Scan ?9History ContdHistory of 2 Sib deaths (