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."— Presentation transcript:
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 3 days Also history of black or tarry stool (malena) 4 weeks ago Also c/o anorexia since 10 days.
. O/E revealed "track" marks on both arms. PALE looks skin Distended abdomen
Lab investigations Hb 8.1 Tlc 4.0 Plts 80 MCV 102 Ur 35 Cr 0.65 Na 138 K 4.5 Chl 104 Bicarb 22
PT 28 APTT 42 INR 4 Albumin 2.3 ECG Normal CHEST X.RAY Unremarkable
What is the differential diagnosis of abdominal pain with fever????
What is the differential diagnosis of faver?
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
Causes of upper GI bleed Esophagitis Esophageal varices Mallor_weiss tear Gastric ulcer Duodenal ulcer Ca stomach
Mallory-Weiss tear A 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.mucus membrane Mallory-Weiss tears are usually caused by forceful or long-term vomiting or coughing. They may also be caused by epileptic convulsions.vomitingcoughingconvulsions Any condition that leads to violent and lengthy bouts of coughing or vomiting can cause these tears.
Bleeding 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.
WHAT FURTHER INVESTIGATIONS YOU WILL ADVISE ON THE BASIS OF THESE LABS??
HbsAg IF +VE THEN GO FOR PCR OF HBV (DNA) Anti HCV. If +ve, then get PCR for HCV (RNA). U/S abdomen. Liver status,shrinkage,any tumor,margins.
There is no vacanation of HCV due to RNA genotype There is a vacination of HBV due to DNA genotype
How many types of viral hepatitis?
Hepatitis A Hepatitis B Hepatitis C Hepatitis D Hepatitis E ( PREGNANCY)
Three 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)
PCR OF HCV (RNA) POSITIVE OR PCR OF HBV (DNA) POSITIVE WITH Decompensated liver disease Decompensated 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 failure It means only symptomatic treatment