A 42-year-old male patient was admitted to the hospital with abdominal distension, decreased appetite, and other symptoms due to chronic alcoholic liver disease. Laboratory tests showed elevated bilirubin and liver enzymes. The patient was diagnosed with alcoholic cirrhosis based on his history of alcohol abuse and laboratory results. He was counseled on lifestyle changes like reducing alcohol intake and a low-sodium diet to manage his condition.

1. 11
CASE Presentation ON Alcoholic CLD
PRESENTED BY:
M.SAI SRUTHI
II/VI PHARM-D
Y17PHD0819
DEPARTMENT OF PARMACY PRACTICE
NIRMALA COLLEGE OF PHARMACY

2. 2
CASE SUMMARY
•A 42 years old male patient who is suffering with chronic
alcoholic liver disease is admitted in the hospital with
chief complaints abdominal distension, decreased appetite,
dyspepsia , sob and P/A free fluid . The patient is also
having abdominal pain ,nausea , pedal edema and
decreased urine output .
•The above case was presented in the format of SOAP
ANALYSIS.

3. 3
SOAP ANALYSIS
SUBJECTIVE EVIDENCE:
A 42 years old male patient who is suffering with chronic alcoholic liver
disease is admitted in the hospital with chief complaints abdominal
distension , decreased appetite , dyspepsia , sob and P/A free fluid.
HISTORY OF PRESENT ILLNESS:
Cough with sputum.
Mild generalized pruritus .
Tremors.
PAST HISTORY:
k/c/o alcoholic CLD.
Type II DM.

4. 44
PERSONAL HISTORY:
• Decreased appetite.
• Mixed diet.
• Regular bowel and bladder habits.
• Normal sleep.
PRESENT MEDICATION:
DRUGS DOSE FREQUENCY
T Dytor 10 mg BD
T Shelcal 500 mg BD
T Vertin 16 mg OD
T Calcol 500mg OD
T Levipil 500 mg BD
T Mecon plus I tab OD

5. 55
• OBJECTIVE EVIDENCE:
PHYSICAL EXAMINATION:
• PR:120b/minute
• Bp:140/70mmHg
• Icterus
SYSTEMIC EXAMINATION:
• CVS:S1S2+
• P/A distension
• RS:BAE+
• CNS:NAD

6. 6
OBJECTIVE:
BIOCHEMICAL LAB TESTS:
SNO PARAMETERS OBSERVED VALUES NORMAL VALUES
1. Bilirubin total 10.63mg/dl 0.1 to 1.2mg/dl
2. Bilirubin direct 5.53mg/dl 0.0 to 0.4mg/dl
3. Bilirubin indirect 5.1mg/dl 0.2 to 1.0mg/dl
4. SGOT 91IU/L 0 to 40IU/L
5. S .albumin 2.3g/dl 3.5 to 5.2
6. S .globulin 4.1g/dl 1.8 to 3.4
7. A/G ratio 0.47 1.1 to 1.8
8. S .sodium 114 mmol/dl 134 to 145
9. S .potassium 5.5mmol/dl 3.5 to 5.1
10. S .creatinine 1.4mg/dl 0 to 1.2

7. 7
COMPLETE BLOOD COUNT:
SNO PARAMETERS OBSERVED
VALUES
NORMAL VALUES
1. Hemoglobin 8.7g/dl 11 to16g/dl
2. WBC 19800cells/cu
mm
10000cells/cu
mm
3. Neutrophils 89% 50 to 81%
4. Lymphocytes 6% 14 to 44%
5. Prothrombin time 31.8sec 9.5 to 14.0sec

8. 88
DIABETIC CHART:
DATE TIME GRBS DRUGS GIVEN
24/1/19 6 AM 331mg/dl 12 Units HA s/c
24/1/19 2 PM 346mg/dl 12 Units HA s/c
24/1/19 6 PM 394mg/dl 12 Units HA s/c

9. 99
ASSESSMENT
• Based on the subjective and objective evidence the patient is
suffering with alcoholic chronic liver disease.
• DEFINITION:
• Alcoholic liver disease is the term used to describe the spectrum of
liver injury associated with acute and chronic alcoholism.
• There are three sequential stages in alcoholic liver disease:
alcoholic steatosis (fatty liver), alcoholic hepatitis and alcoholic
cirrhosis.

10. 1010
• CAUSES:
• Chronic alcohol abuse.
• Chronic viral hepatitis (hepatitis B, C and D)
• Fat accumulating in the liver (nonalcoholic fatty liver disease)
• Iron buildup in the body (hemochromatosis)
• Cystic fibrosis
• Copper accumulated in the liver (Wilson's disease)
• Poorly formed bile ducts (biliary atresia)
• Alpha-1 antitrypsin deficiency
• Inherited disorders of sugar metabolism (galactosemia or glycogen storage disease)
• Genetic digestive disorder (Alagille syndrome)
• Liver disease caused by your body's immune system (autoimmune hepatitis)
• Destruction of the bile ducts (primary biliary cirrhosis)
• Hardening and scarring of the bile ducts (primary sclerosing cholangitis
• Infection, such as syphilis or brucellosis
• Medications, including methotrexate or isoniazid

11. 1111
• RISK FACTORS:
• Drinking too much alcohol.
• Being overweight.

12. 1212

13. 13
PATHOPHYSIOLOGY:

14. 14

15. 1515
SYMPTOMS:
• Fatigue,Easily bleeding or bruising.
• Loss of appetite.
• Nausea.
• Swelling in your legs, feet or ankles (edema).
• Weight loss.
• Itchy skin.
• Yellow discoloration in the skin and eyes (jaundice).
• Fluid accumulation in your abdomen (ascites).
• Spiderlike blood vessels on your skin.
• Redness in the palms of the hands.
• For women, absent or loss of periods not related to menopause.
• For men, loss of sex drive, breast enlargement (gynecomastia) or testicular
atrophy.
• Confusion, drowsiness and slurred speech (hepatic encephalopathy).

16. 1616
STANDARD TREATMENT:
• Medications to control signs and symptoms of CLD.
• Treatment for alcohol dependency.
• Weight loss.
• medications to control hepatitis.
• TREATMENT FOR COMPLICATIONS OF CLD:
• Treat excess fluid in body(ascites).
• Portal hypertension.
• Treat hepatic encephalopathy.
• Treat infections.
• LIVER TRANSPLANTATION SURGERY.

17. 17
DRUG CHART:
S
n
o
Drug
name
Dose ROA Freq Duration Indication Category MOA Side effects Monitoring
parameters
1. T.Monc
ef
1 g oral BD D1 D2 To treat
infection
Cephalosp
orin (3rd
generation
)
Inhibit bacterial
cell wall
synthesis.
Headache,rash
.
Monitoring
renal functions.
2. T
Levepil(l
vetriace
tam)
500
mg
oral BD D1 D3 To treat
seizures
Anticonvul
sant
inhibition of
voltage-
deGABA-ergic
inhibitory
transmission
Headache,anxi
ety,dizziness.
Monitor CNS
dpression
,nervousness,C
BC.
3. T
Mecon
plus
1 tab oral OD D1 D3 To treat
weakness
Vitamin
supplemen
t
- - Monitor Bp.
4. T.Calcol 1 tab oral OD D1 D2 To treat
hypocalemia
- - dry
mouth,muscle
pain,vomiting,c
onstipation
Monitor
dehydration.

18. 18
S
n
o
Drug
name
Dose ROA Freq Duration Indication Category MOA Side effects Monitoring
parameters
5. Pentasur
e hepatic
acid
1
scoop
oral OD D1 D2 To treat
liver
aliments.
- - Vomiting,naus
ea,head
ache,vertigo.
Monitor
signs and
symptoms.
6. Inj
Meropene
m
1 g IV TID D2 D3 To treat
infection
Carbapen
em.
Inhibit
bacterial cell
wall
synthesis.
headache,shoc
k,tachycardia,p
ruritis,pelvic
pain.
monitor
LFTs,CBC,re
nal functions.
7. Syp
Looz(lactul
ose)
30 ml Oral 8 th
hr
D2 D3 To treat
constipatio
n
laxative Produces
osmotic
effect.
Dehydration,hy
pernatremia,hy
perkalemia,vo
miting.
Bp,serum
electrolytes.
8. T Ab
phylline(a
cebrophyl
line)
100
mg
oral BD D1 D3 To treat
sob
Phosphod
iesterase
enzyme
inhibitor
inhibition of
the
intracellular
phosphodieste
rases,
Gi
bleeding,fever
with chills.
HR
,RR,CNS
effects

19. 19
S
no
Drug name Dose ROA Freq Duration Indication Category MOA Side effects Monitoring
parameters
8. Hepcure
sachets
1 in 1
glass
water
oral TID D2 D3 To treat liver
aliments.
- - vomiting,nause
a.
Monitor
signs and
symptoms.
9. T
Rifagut(rifa
ximin)
550m
g
oral TID D2 D3 To treat
infection
rifamycin Inhibits
bacterial RNA
synthesis.
Peripheral
edema,dizzine
ss,fatigue,ascit
es,nausea,hea
dache.
Hypersensiti
vity
rxns,blood in
stools,temp.
10. Inj
Thiamine
100m
g
IV OD D2 D3 To treat
thiamine
deficiency.
- - Pain
,redness,sweat
ing,weakness.
Monitor
signs and
symptoms.
11. T.Tolvapto
ne
15mg oral OD D2 D3 To treat low
salt levels.
Vasopressi
n
antagonist.
Promotes
excretion of
free water.
fatigue,dizzine
ss,nausea,palp
itations.
Monitor
serum
electrolytes,
neurologic
status.

20. 2020
PATIENT COUNSELLING
ABOUT DISEASE:
• Alcoholic liver disease is the term used to
describe the spectrum of liver injury
associated with acute and chronic alcoholism.
It is caused due to
• ALCOHOL ABUSE

21. 2121
ABOUTLIFESTYLE:
• Reduce saturated fat and cholesterol.
• Stop smoking and drinking alcohol.
• Maintain healthy weight.
• Get regular exercise.
• Learn to fight stress.
• Eat a balanced diet.
• Avoid raw seafood, raw fish, and shellfish.
• Discuss the appropriate amount of protein you need to eat.
• Take any vitamin or mineral supplements recommended by your doctor.
• A low-salt diet may be needed to reduce fluid retention.

22. 2222
REFERENCES
• www.hopkinsmedicine.org
• www.mayoclinic.org
• wikipedia.org
• Robbin basic pathology
• www.winchesterhospital.org
• Harsha mohan textbook of pathology.