Presentation on theme: "A 40-year-old male NKCM,but the history of iv drug abuser for many years presented to the ER with C/O severe abdominal pain associated with fever since."— Presentation transcript:
2A 40-year-old male NKCM,but the history of iv drug abuser for many years presented to the ER with C/Osevere abdominal pain associated with fever since 3 daysAlso history of black or tarry stool (malena) 4 weeks agoAlso c/o anorexia since 10 days.
3. O/E revealed "track" marks on both arms. PALE looks skinDistended abdomen
15(i) hematemesis vomiting of blood Bleeding from a lesion in the esophagus,stomach, and duodenum is called upper GI bleed.(i) hematemesis vomiting of blood(ii) malena, passage of black tarry stool
16Causes of upper GI bleed EsophagitisEsophageal varicesMallor_weiss tearGastric ulcerDuodenal ulcerCa stomach
17Mallory-Weiss tearA Mallory-Weiss tear occurs in the mucus membrane of the lower part of the esophagus or upper part of the stomach, near where they join. The tear may bleed.Mallory-Weiss tears are usually caused by forceful or long-term vomiting or coughing. They may also be caused by epileptic convulsions.Any condition that leads to violent and lengthy bouts of coughing or vomiting can cause these tears.
18Bleeding esophageal varices Bleeding esophageal varices are enlarged veins in the walls of the lower part of the esophagus that bleed. The esophagus is the tube that connects your throat to your stomach.
19Causes of oesophageal varices Pre-hepaticPortal vein thrombosis.Portal vein obstruction - congenital atresia/stenosis.Increased portal blood flow - fistula.Increased splenic flow.Intra-hepaticCirrhosis due to various causes, including alcoholic, chronic hepatitis (eg viral or autoimmune).Idiopathic portal hypertension (hepatoportal sclerosis).Acute hepatitis (especially alcoholic).Schistosomiasis.Congenital hepatic fibrosis.Myelosclerosis.Post-hepaticCompression (eg from tumour).Budd-Chiari syndrome.Constrictive pericarditis (and rarely right-sided heart failure).
30Three things for liver function monitoring LFTs (If LFT derrange specialy SGPT it means liver problem developed)PT, APTT, INR (if pt ,aptt,INR incresase it means acute liver problem)Albumin (If Albumin decrease it means with PT,APTT,INR, increase it means chronic liver problem)
31PCR OF HCV (RNA) POSITIVE OR PCR OF HBV (DNA) POSITIVEWITHDecompensated liver diseaseDecompensated liver disease means that the medications and treatments used to treat the liver is no longer working very well and the liver is near total failureIt means only symptomatic treatment