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Doctors Lounge - Gastroenterology Answers
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| ankukreja
- Mon Jan 29, 2007 6:11 am |
|
I am Dr Kukreja from India
I am a Surgical Gastroentrologist from India
My aunt is suffering from Liver disease can U please advise me if she needs interferon therapy
Patient record:
Age: 54 years 28 days
Gender: Female Color:
Marital Status: Married Occupation:
Address: Ahmedabad Postal Code:
Observations:
Case Histories
Date: 01/01/2007
Gastroscopy Report Done On : 01/11/2006
Oesophagus : Z Line at 30 Cms , GER + , Early Grade II Oesophageal Varices
Stomach : Normal with prominent Fundal Veins
Duodenum : N
Date: 01/01/2007
Consultations & Follow-ups
Date: 01/01/2007
DoA:
Do Surgery:
DOD:
OPD/IPD NO :
Ref By : Dr. Kukreja
Chief Complaints : Anemia ++
Pain in abdomen , Off and On , appetite normal , G I Bleeding in May 2005 for few months
PCV 4 units infused
Past History: H/O DM On Oral Medications
HT For last 3-4 years
Hypothyroidism last 24-25 years
Hysterectomy done 20 years back
Operated for Umbilical Hernia 20 years back
ARF 21/05/2005 Recovered
No Past History of TB , MI , IHD , Stone , UTI Etc
Family History: No H/O DM , HT or anyother major medical illness
Personal History : Nothing Relevant
Drug Sensitivity : Nill
General Examination :
Conciousness : N
Co-Operativeness : N
Built [Wt] :
Nourishement : Adequate
Pulse : 108/min
Blood Pressure : 126/76
R.R : N
Temprature : N
Alimentary System :
Tenderness : +nt Vague all over Peristalsis : +nt
Gaurding/Rigidity : -nt Lump : -nt
Umbilicus :N Ascites : -nt
Liver :NP Spleen :NP
Free Blood : -nt Distended Veins :-nt
External Genitals:N Hernial Sites :N
PR - PV : N
Proctoscopy : N
Clinical Impression :
? Cirrhosis Of Liver
_____________________13/05/2006_____________________
Hb : 4.9 Gm%
_____________________18/05/2006_____________________
Platelet Count : 1,51,000/cmm
_____________________18/05/2006_____________________
Platelet Count : 1,22,000/cmm
_____________________07/06/2006_____________________
Platelet Count : 1,30,000/cmm
_____________________22/06/2007_____________________
Hb : 8.60 Gm%
Platelet Count : 1,37,000/Cmm
_____________________12/08/2005_____________________
Urine : NAD
HB : 6.40
Serum Iron : 30.30 mcg/dl
Total Iron Binding Capacity : 434.0 mcg/dl
Stool : NAD
_____________________06/09/2006_____________________
Hb : 7.7 gm %
Total WBC : 3120 / cmm
Platelet Count : 1,12,000 / cmm
_____________________12/09/2006_____________________
Platelet Count : 1,61,000/cmm
_____________________18/07/2006_____________________
ANA : Negative
Serum Iron : 23*
Transferrin Saturation : 6.3* %
CT Upper Abdomen : Mild Periportal Fibrosis , Borderline Splenomegaly ,
Increased Diameter Of Portal & Splenic Veins ,
Suggest mild changes of Portal hypertension
USG Upper Abdomen : Fatty Changes in Liver
_____________________18/10/2005_____________________
PPBS : 201 mg%
S Creatinine : 1.10 Mg/DL
Serum Potasium : 5.20 MEq/L
Serum Iron : 54.70 mcg/dl
Total Iron Binding Capacity : 391.0 mcg/dl
Hb : 6.8 gm %
Platelet Count : 1,48,000/cmm
ANA : Positive Intensity on Immunoflourescence
_____________________30/10/2006_____________________
TSH 0.03 Microunits/ml
_____________________11/11/2006_____________________
Platelet Count : 86,200/Cmm
_____________________06/11/2006_____________________
Generalised Oedema 1.5 years
Kn HT ,DM ,Hypothyroid
Recurrent Anemia , Transfusion Twice
AntiHCV : Reactive
HbsAg : Negative
Hb : 8.5 gm%
Platelet Count : 10,8000/cmm
Diagnosis : HCV Related CLD
Small Oesophageal Varices
Rx :
Tab Dytor 20 1 BD
Tab Zifi 30 1 OD
Tab Beplex Forte 30 1 BD
Liq Dupulac 20 ML HS
Cap Esogard 1 OD
_____________________08/12/2006_____________________
S Creatinine : 1.70 mg/dl
_____________________16/12/2006_____________________
Hb : 7.90 gm%
Platelet : 89,600/cmm
_____________________22/06/2006_____________________
Platelet Count : 1,37,000/cmm
_____________________06/09/2006_____________________
Platelet Count : 1,12,000/cmm
_____________________14/10/2006_____________________
Platelet Count : 1,48,000/cmm
_____________________25/12/2006_____________________
HCV RNA [RT-PCR] 484000 IU/ml
-------
Thanking you in Anticipation
Regards
Dr Kukreja
|
| Dr. Yasser Mokhtar
- Fri Mar 23, 2007 3:21 pm |
|
 Dear Dr. Kukreja,
Treatment with interferon is not an easy decision given the potential side effects and the cost of such medicine.
The patient who is to be treated must be evaluated by a gastrointerologist who is specialized in treating hepatitis c infection with interferon and not just any gastroenterologist.
Thank you very much for using our website http://doctorslounge.com and I hope that this information helped.
Yasser Mokhtar, M.D.
|
| D. Guido, PAC
- Tue Feb 19, 2008 1:41 pm |
|
Interesting case report. Thanks for all the good data. What stands out for me is the G I Bleeding in May 2005 for few months. I terms of treating the patient with interferon, the source of the bleeding is important in determining if the patient is a candidate for therapy. From the data you provided, it is unclear if the source of the bleeding is from the esophageal varices or some other source. If the bleed is from her esophageal varices, then we could make a presumptive diagnosis of decompansated liver disease most likely from portal hypertension 2/2 HCV cirrhosis. If this is the case, then the patient is unsuitable for antiviral therapy at this time. We do treat patients with decompansated cirrhosis from time to time and is on a case by case basis. Generally, if the decompansating event (be it encephelopathy, esophageal varicial bleeding or ascites) is stable for ~6 mos or so, one can attempt to treat. Usually all these patient have already been listing for liver transplant as a safety net.
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