44 yr male with ALD

This is a case of 44year old male diagnosed with ALCOHOLIC LIVER DISEASE(ALD)

 CHIEF COMPLAINTS

 44 year old male came to casualty with chief complaints of fever since 1 week which is high grade and associated with chills and rigors

HOPI 

Patient was apparently asymptomatic 12 years back, and he had history of intake of alcohol initially 90 ml gradually progress to amount of 200 ml since2 years. Patient was on alcohol which is about 200 ml initially and then the quantity increased to daily intake of 300 ml with no or minimal food intake. He had shortness of breath and also had generalised weakness. Patient became tachypneic over night(RR 18-32cpm) and also had 2 fever spikes and saturation dropped to 82% on RA and also had respiratory distress H/O agressive behaviour previously but now it got subsided 

Previously tremors +

 Decreased appetite 

 yellowish discoloration of sclera is present vomiting of 1 episode 

patient was admitted in outside hospital and treated as alcoholic liver disease With TB - 23.7 gradually reduced to 2.5. pain abdomen+ 

PSYCHIATRY REFERRAL 

Imp-Alcohol dependence syndrome Tobacco harmful use UROLOGIST REFERRAL

 Imp- he was diagnosed with EMPHYSEMATOUS PYELONEPHRITIS treated in outside hospital for ALCOHOLIC LIVER DISEASE

 PAST HISTORY

 N/K/C/O - DM, ASTHMA,TB , EPILEPSY.

 PERSONAL HISTORY 

Married

 Diet-mixed

 Appetite - lost 

 Sleep-Decreased Bowel and bladder movements

 regular known alcoholic since 12 years. 

GENERAL EXAMINATION 

Pallor-absent

 Icterus-present(yellowish discoloration of sclera)

cyanosis, clubbing of fingers ,lymphadenopathy-absent dehydration - present 

 Vitals:

Temperature - febrile PR-100bpm BP-130/90 mmHg RR-32 cpm spo2 - 100% on 6L of O2 Grbs - 85 mg % S

SYSTEMIC EXAMINATION

 CVS - S1,S2 heard ,no murmurs 

 Respiratory system-Coarse crepts B/L basal areas

 P/A -abdomen distended with palpable spleen ,tenderness+ over the left hypochondrium   

 CNS - NAD , Glasgow scale - 15/15 

INVESTIGATIONS: 

 ECG 

 ULTRASONOGRAPHY 

PROVISIONAL DIAGNOSIS:

 ALD WITH ALCOHOL DEPENDENCE WITH AKI 

TREATMENT: 

1) IVF NS,RL,DNS @50ml/hr 

2)INJ THIAMINE 1AMP IN 100ML NS IV/TID 3)INJ TRAMADOL 1AMP IN 100ML NS IV/TID 4)INJ BUSCOPAN 2 CC IV/SOS 

5) INJ PANTOP 40.MG IV/OD 

 6)INJ ZOFER 4 MG IV/SOS 

 7) INJ NEOMOL 100 ML NS IV / SOS (IF TEMP GREATER 101 F ) 

8) TAB PCM 500 MG.PO/TID

 9)TAB UDILIV 300MG PO/BD 

10)TAB RIFAGUT 550MG PO/BD

 11)SYP HEPAMERZ 15ML PO/BD 

12)SYP LACTULOSE 10ML PO/HS/TO PASS 

STOOLS DISCUSSION: The mechanism of ALD is not completely understood. 80% of alcohol passes through the liver to be detoxified. Chronic consumption of alcohol results in the secretion of pro-inflammatory cytokines (TNF-alpha, Interleukin 6 [IL6] and Interleukin 8 [IL8]), oxidative stress, lipid peroxidation, and acetaldehyde toxicity. These factors cause inflammation, apoptosis and eventually fibrosis of liver cells. There are 3 types of alcoholic liver disease related to alcohol consumption:fatty liver,alcoholic hepatitis or cirrhosis.