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Tph1512020[1020]
- 1. Case study Portal hypertension ascites By sadaf saifi Doctor of pharmacy
- 2. case A male patient of 65 years was brought in emergency to Teerthanker Mahaveer hospital with of discomfort, breathlessness progressively increasing.
- 3. Demographic details Patient name :- Mr. Ram kumar Age/sex :- 65/male CR number :-1904051408 weight :- 79 kgs . Date of admission :- 20/08/2018 Consultant doctor :- Dr. V.k :- Dr. Amit Mishra.
- 4. Patient complaints Breathlessness Discomfort in abdominal area. Swollen belly
- 5. Patient history No social history (non smoker , non alcoholic ) No family history Patient is a k/c/o HTN x 10 years. CLD decompensated since 6 months
- 6. Physical examination General appearance normal Cardiovascular k/c/o htn Abdomen swollen Color pale yellow Clot absent PI-CCLE-
- 7. Vital signs s.n o 1 Blood pressure 170/90 2 Temperatur e 98.2 3 pulse 82bpm 4 Respiratory rate 20bpm
- 8. Diagnosis CLD (? NACLD ) Portal hypertension ascites ? Large esophageal varices?
- 9. Laboratory tests:- Ascitic fluid analysis CBC, LFT, PT/INR S.Cr, Na+, K+ ECG,
- 10. Goal of treatment - To relieve symptoms - To prevent disease progression - To improve exercise tolerance - To improve overall health status - To prevent and treat ascites - To prevent and treat complications such as bleeding - To reduce morbidity and mortality
- 11. Laboratory outcomes (06/04/19) Laboratory parameter 06/04 07/04 08/04 09/04 Normal range Haemoglobin 13.9 13.0-17.0 gm/dl PCV 41.2 L 42-52% Glucose 110 H 40-80mg/dl1-1 Protein 1.75 H gm/dl Urea 73.0 H 77.0 72.0 65 13-45 mg/dl Creatinine serum 3.75 H 3.04 2.41 2.27 0.50-1.20 mg/dl Sodium 127.0 L 129.0 127.0 130 135-155 mEq/L chloride 88.0 L 93.0 91.0 94.0 90-120 mEq/L Bilirubin total 2.0 H 0.20-1.00mg/dl Bilirubin direct 0.7 H 0.00-0.40 mg/dl Bilirubin indirect albumin 1.3 H 0.0-0.7 mg/dl Alt / SGPT 16.0 5-40 IU/L AST/SGOT 35.0 5-40 IU/L Weight 79 kg 75kg Abdomen (cm) 49cm 43cm
- 12. S.N o Drug prescribed Generic name. Dose frequen cy Route Therapeutic use Side effects 06/ 04 07/ 04 08/ 04 1 Inj. Pansec pantaprazo l 40mg BD IV GERD acid reflux and peptic ulcer disease. Diarrhea , flatulence -- -- 2 Tab. Ciplar LA Propanolol 20mg OD Oral High BP, chest pain, migraine Night mare , slow heart rate dizziness -- -- -- 3 Inj. Taxim Cefotaxime 2 gm TDS IV Bacterial infection Injection site reaction, diarrhea Sodium increment -- -- -- 4 Tab. Rcifax Rifaximin 550mg OD oral hepatic encephalopathy Headache , vomiting -- -- -- 5 Tab. Lasilactone 50 Dose adjust ment in case of CLD OD oral Oedema ↓ sodium level Magnesium Calcium Breast enlargement in male. -- *condom catheters should be used.
- 13. S.No Drug Generic name Dose frequenc y route Therapeutic use Side effects 06/ 04 07/ 04 08 /0 4 6 Syp. Osmitol 30ml BD oral constipation dehydration -- -- -- 7 Tab. Metrogyl Metronidazol 400mg BD oral Bact. And parasitic infection Dryness in mouth -- -- -- -- -- -- -- -- 8 Inj. H Albumin 20% NS Increases plasma volume or serum albumin Severe stomach cramps -- -- -- 9 Tab. Pantop Pantaprozole 40mg OD oral GERD Diarrhea, nausea
- 14. Patient counselling Good afternoon. Hello Mr. Ram My name is sadaf saifi, a clinical pharmacist. I am here to guide you about your medication, disease and life style modification. Ok what do you know about your disease . You were admitte in emergency due to discomfort in your abdomen. From how long you are facing this problem ? Can you tell me something about your symptoms? What did your doctor tell yu about the medication . Ok, I vl be telling you everything in detail.
- 15. You have been suffering from chronic liver disease. A disease process of the liver that involves a process of progressive destruction and regeneration of the liver parenchyma leading to fibrosis and cirrhosis Liver enlargement is the cause of your disease. Symptoms are: Progressive destruction of the liver May be asymptomatic in early or mild cases Build-up of fluid in abdomen - ascites Enlarged breasts in men Coughing blood Vomiting blood Impaired nerve functions Itching Portal hypertension
- 16. Portal hypertension with ascites The most significant problems associated with portal hypertension are ascites (the accumulation of excess fluid in the tissues lining the organs and the abdominal wall) and varices (engorged veins along the esophagus, stomach or intestines caused by backed-up blood flow). Varices are directly caused by portal hypertension. Symptoms Gastrointestinal bleeding marked by black, tarry stools or blood in the stools, or vomiting of blood due to the spontaneous rupture and hemorrhage from varices Ascites an accumulation of fluid in the abdomen. Encephalopathy or confusion and forgetfulness caused by poor liver function. LARGE ESOPHAGEAL VARICES Esophageal varices (sometimes spelled oesophageal varices) are extremely dilated sub-mucosal veins in the lower third of the esophagus. They are most often a consequence of portal hypertension, commonly due to cirrhosis; patients with esophageal varices have a strong tendency to develop bleeding.
- 17. Medications given to you are described properly with their use and side effects in medication chart. Lifestyle changes such as stress reduction , Exercise And dietary. Liquid or fluid intake should be prohibited. If you are missing anything or you did not remember please let me know. Avoid sodium in your diet.