3. PERSONAL HISTORY:PERSONAL HISTORY:
• Female patient, 28 years old,Female patient, 28 years old, married 3 years agomarried 3 years ago
mother of one girl 2 years old, housewifemother of one girl 2 years old, housewife..
• Born and living in Giza, with history of contact withBorn and living in Giza, with history of contact with
canal water but she did not receive antischistosomal ttt.canal water but she did not receive antischistosomal ttt.
• No special habits of medical importance.No special habits of medical importance.
• Menarche at 13 with history of OCPsMenarche at 13 with history of OCPs Kind if possibleKind if possible intakeintake
for 2 months before the onset of her illness. Menses arefor 2 months before the onset of her illness. Menses are
regular with average amount 4/28.regular with average amount 4/28.
5. PRESENT HISTORY:PRESENT HISTORY:
• The condition startedThe condition started 5 months5 months ago adjustago adjust
timetime by gradually progressiveby gradually progressive jaundicejaundice, dark, dark
colored urine but she did not notice change incolored urine but she did not notice change in
color of stools and no itching.color of stools and no itching.
6. The condition was not associated with:The condition was not associated with:
• Fever, rigors ,abdominal pain or vomiting.Fever, rigors ,abdominal pain or vomiting.
• Bleeding tendency, haematemesis, melena,Bleeding tendency, haematemesis, melena,
ascites, LL edema or DCL.ascites, LL edema or DCL.
• History suggestive of anaemia or bloodHistory suggestive of anaemia or blood
transfusion.transfusion.
• Joint pains or skin rash.Joint pains or skin rash.
• Weight loss or perception of body masses.Weight loss or perception of body masses.
• History of traveling abroadHistory of traveling abroad
7. • During hospital stay she hadDuring hospital stay she had degreedegree traumatrauma
to RT foot (torsion) fracture base ofto RT foot (torsion) fracture base of
the 5the 5thth
metatarsal bone cast wasmetatarsal bone cast was
appliedapplied for how long?for how long? and no medications wereand no medications were
given.given.
8. PAST HISTORY:PAST HISTORY:
• No diabetes mellitus or systemic hypertension.No diabetes mellitus or systemic hypertension.
• History of Caesarian section 2 years ago with noHistory of Caesarian section 2 years ago with no
postoperative complications and no blood transfusion.postoperative complications and no blood transfusion.
• History of drug intake (intermittent intake of NSAIDsHistory of drug intake (intermittent intake of NSAIDs
indication and dosage on the averageindication and dosage on the average and OCPS for 2 months beforeand OCPS for 2 months before
onset of illness).onset of illness).
FAMILY HISTORY:FAMILY HISTORY:
No similar conditions in the family.No similar conditions in the family.
10. GENERAL EXAMINATION:GENERAL EXAMINATION:
• The patient is fully conscious, well oriented to time,The patient is fully conscious, well oriented to time,
place and persons, of average mood and mentality.place and persons, of average mood and mentality.
• Average body weight.Average body weight.BMIBMI
• Blood pressure: 120/80.Blood pressure: 120/80.
• Pulse: 80/min, regular, equal on both sides, with intactPulse: 80/min, regular, equal on both sides, with intact
peripheral pulsations.peripheral pulsations.
• Temperature: afebrile all through hospital stay.Temperature: afebrile all through hospital stay.
11. HEAD AND NECK:HEAD AND NECK:
• Jaundice.Jaundice.
• No pallor or cyanosis.No pallor or cyanosis.
• No palpable lymph nodes.No palpable lymph nodes.
• Trachea central.Trachea central.
• Thyroid gland not felt.Thyroid gland not felt.
• Neck veins are not congested.Neck veins are not congested.
12. UPPER LIMBS:UPPER LIMBS:
• No palmar erythemaNo palmar erythema,, spider naevi, flappingspider naevi, flapping
tremors itching marks or clubbingtremors itching marks or clubbing
• Ecchymotic patches at sites of injections.Ecchymotic patches at sites of injections.
LOWER LIMBS:LOWER LIMBS:
No edema.No edema.
14. ABDOMINAL EXAMINATION:ABDOMINAL EXAMINATION:
• Normal shape and contour.Normal shape and contour.
• Right Subcostal angleRight Subcostal angle
• NoNo Divarication of the recti.Divarication of the recti.
• Umbilicus: normal shape and position with noUmbilicus: normal shape and position with no
impulse on cough.impulse on cough.
• PfennestialPfennestial incision 10 cms healed by 1ry intention.incision 10 cms healed by 1ry intention.
• No abdominal wall veins or pigmentationsNo abdominal wall veins or pigmentations..
15. • SUPERFICIAL PALPATION:SUPERFICIAL PALPATION:
No tenderness, rigidity or masses detected.No tenderness, rigidity or masses detected.
• LIVER:LIVER:
-- Upper borderUpper border: 5: 5thth
space mid clavicular line.space mid clavicular line.
-- Lower borderLower border::
RT LOBE not feltRT LOBE not felt
LT LOBE is detected 5 cms belowLT LOBE is detected 5 cms below
xiphisternum by light percussionxiphisternum by light percussion
• SPLEENSPLEEN:: felt 3 cms below left costal margin (firmfelt 3 cms below left costal margin (firm
--sharpsharp border – not tenderborder – not tender
• No ascites by shifting dullness.No ascites by shifting dullness.
16. To summarizeTo summarize
• 28 years old female patient28 years old female patient
• Jaundice for 5 monthsJaundice for 5 months
• No history suggestive of hemolysisNo history suggestive of hemolysis
• No history suggestive of LCFNo history suggestive of LCF
• History of OCPsHistory of OCPs
• SplenomegalySplenomegaly
22. ABDOMINAL ULTRASOUND:ABDOMINAL ULTRASOUND:
• LIVER:LIVER:
Average in size, coarse echopattern, regular surface, attenuated hepatic veins,Average in size, coarse echopattern, regular surface, attenuated hepatic veins,
no focal lesions or IHBR dilatation. PV is not dilated.no focal lesions or IHBR dilatation. PV is not dilated.
• GALL BLADDERGALL BLADDER::
Contracted but it is seenContracted but it is seen calcular.calcular. CBD is not dilated.CBD is not dilated.
• SPLEEN:SPLEEN:
Enlarged (Enlarged (17cms17cms), homogenous .), homogenous .
• KIDNEYS:KIDNEYS:
Both showed average size, parenchymal thickness, normal echogenicity, noBoth showed average size, parenchymal thickness, normal echogenicity, no
calculi or back pressure changes.calculi or back pressure changes.
• MIDLINE structure:MIDLINE structure: free.free.
• NO ASCITESNO ASCITES
• CONCLUSION:CONCLUSION:
– Chronic parenchymatous liver diseaseChronic parenchymatous liver disease
– SplenomegalySplenomegaly
26. UPPER GIT ENDOSCOPY:UPPER GIT ENDOSCOPY:
• EsophagusEsophagus: Incompetent cardia: Incompetent cardia
• Stomach:Stomach: The whole gastric mucosa is hyperaemic andThe whole gastric mucosa is hyperaemic and
edematous( mosaic pattern)edematous( mosaic pattern)
• Pyloric ringPyloric ring:: Rounded and active.Rounded and active.
• DuodenumDuodenum:: Free down to the second part.Free down to the second part.
CONCLUSION:CONCLUSION: Congestive gastropathyCongestive gastropathy
27. LIVER BIOPSYLIVER BIOPSY
GROSS:GROSS:
Partially fragmented core totally submittedPartially fragmented core totally submitted
MICROSCOPIC:MICROSCOPIC:
Hepatic tissue exhibiting widely expanded portalHepatic tissue exhibiting widely expanded portal
tract showing marked fibrosis ,small bile ducttract showing marked fibrosis ,small bile duct
proliferation and wide exudation of lymphocytesproliferation and wide exudation of lymphocytes
together with neutrophils ,eosinophils,some plasmatogether with neutrophils ,eosinophils,some plasma
cells some histiocytes. Focal inflammatory-cells some histiocytes. Focal inflammatory-
lymphocytic bile duct injury is noted . There is littlelymphocytic bile duct injury is noted . There is little
parenchyma (in the biopsy) showing reactive atypiaparenchyma (in the biopsy) showing reactive atypia
with no steatosis or conspicuous nuclearwith no steatosis or conspicuous nuclear
glycogenation.glycogenation.
Staining for copper showsStaining for copper shows mild copper overloadmild copper overload..
28. CONCLUSION:CONCLUSION:
Portal florid fibroinflammatory pattern withPortal florid fibroinflammatory pattern with
bile ductular proliferation with mild copperbile ductular proliferation with mild copper
overload.overload.
1ry BILIARY CIRRHOSIS1ry BILIARY CIRRHOSIS
V.SV.S
DRUG HEPATITISDRUG HEPATITIS
