News  |  Journals  |  Conferences  |  Blogs  |  Articles  |  Forums  |  Twitter   
 

 Headlines:

 
 

Doctors Lounge - Gastroenterology Answers

"The information provided on www.doctorslounge.com is designed to support, not replace, the relationship that exists between a patient/site visitor and his/her physician."

Back to Gastroenterology Answers List

Forum Name: Liver Diseases

Question: Does She Need Interferon Therapy ?


 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

User avatar 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.

|

Check a doctor's response to similar questions

 

advertisement.gif (61x7 -- 0 bytes)
 

Are you a Doctor, Pharmacist, PA or a Nurse?

Join the Doctors Lounge online medical community

  • Editorial activities: Publish, peer review, edit online articles.

  • Ask a Doctor Teams: Respond to patient questions and discuss challenging presentations with other members.

Doctors Lounge Membership Application

 
     

 advertisement.gif (61x7 -- 0 bytes)

 

 

Tools & Services: Follow DoctorsLounge on Twitter Follow us on Twitter | RSS News | Newsletter | Contact us

 
Copyright © 2001-2010
Doctors Lounge.
All rights reserved.

Medical Reference:
Diseases | Symptoms
Drugs | Labs | Procedures
Software | Tutorials

Advertising
Links | Humor
Forum Archive
CME Articles

Privacy Statement
Terms & Conditions
Editorial Board
About us | Email

We subscribe to the HONcode principles of the HON Foundation. Click to verify.We subscribe to the HONcode principles.
Verify here