52 year old male with portal HTN

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 A 52 year old male head on stable by occupation, resident of nalgonda came with complaints of :

• B/L pitting pedal edema (till thighs) since 3 months
• SOB on exertion since 1 week

HOPI :

Patient was apparently asymptomatic 4 years back then developed yellowish discolouration for which he was treated in Hyderabad.

2 years back he went to a hospital with similar complaints but didn’t cooperate for treatment in Hyderabad.

Later he started having hallucinations.

He was sent to de addiction center for 3 months in 2020.

He was working normally after that for 4 months but started consuming alcohol again.

 In January 2022 he developed B/L lower limb swelling associated with blisters and B/L lower limb pain.  

Yellowish discolouration of eyes for 3 weeks for which he got admitted in yashoda hospital and treated.

PT : 21.9

APTT : 37.5

INR : 1.62

Creat : 0.50

Ascitic fluid taken. Albumin in fluid <1 g/dl

Endoscopy done - showed erosions in body and antrum.

LFT -

TB : 11.30

DB : 4.30

ALP : 187

Protein : 6.60

Albumin : 2.5

TLC : 15000

INR : 2.27

Patient got discharged.

Again on 17 March went to hospital with C/O SOB at rest and B/L LL swelling, redness and pain, cough with sputum.

INR : 2.09

TB : 2.40

DB : 0.30

D Dimer : 5405

USG Doppler : Floating thrombus in right CFV and left popliteal vein.

CT : Mild left plural effusion, moderate Ascitis, CLD

2 D Echo : Normal

CT peripheral venograph : Left common lliac vein indented by right common iliac artery. Distal SFV, popliteal veins are thrombosed on right side.

S/P : IVC filter

On 7 May 2022

C/O SOB on exertion since 5 days, vomitings + loss of appetite + B/L lower limb edema + Discharge + right lower limb non healing ulcer since 2 days, fever on and off since 2 days.

Creat : 2

INR : 7.33

On 8 May 2022

Creat : 1.6

INR : 3.55

Stool for occult blood +ve 

11 May 2022

Creat : 0.62

INR : 2.62

USG : Hepatosplenomegaly, moderate ascitis 

Endoscopy : Reflux esophagitis, LA lax LES, astral erosions, portal HTN changes.

Came to this hospital on 14 May 2022 to get admitted in DAC.

Addictions :

Chronic alcoholic since 30 years

Chronic smoker since 40 years 

General examination:

No pallor, cyanosis, clubbing, lymphadenopathy

Icterus +

Edema + up to thighs

Vitals :

Temperature : 98.1 F

Pulse : 88 bpm

RR : 19 cpm

BP : 120/70 mm hg

SpO2 : 98% on RA

GRBS : 116 mg/dl

Systemic examination :

CVS : S1 S2 +

RS : BAE +

CNS : NAD

PA : Soft, distended

Provisional Diagnosis : 

? DCLD with Portal HTN 

? Left LL cellulitis with left LL DVT and PTE with S/P IVC filter placement.

Investigations :

HB : 6.8

TLC : 5600

Plt : 1 lakh

LFT -

TB :3.25

DB : 1.65

AST : 41

ALT : 19

ALP : 218

TP : 5.1

ALB : 2.35

RFT -

S. Urea : 14

Creat : 0.9

Sodium : 139

Potassium : 3.3

Chloride : 101

CUE -

Alb +

PT : 20

INR : 1.4

APTT : 40

Surgery referral :

         

Treatment :

T. PENTOXYPHILLINE 400mg PO/BD 

T. PAN D 40 mg PO/OD

T. UDILIV 300mg PO/BD

T. LASILACTONE 50mg PO/OD

T. BENFOTHIAMINE PO/OD

THIAMINE INJ

IVF @ 30ML /HR