A 55-year-old male presented with jaundice, decreased urination, and swelling of the body for 1 month. He has a history of alcoholism and smoking for 3 years. Laboratory tests revealed elevated bilirubin, liver enzymes, and signs of portal hypertension. He was diagnosed with alcoholic liver disease. Treatment included medications to protect the liver, manage complications, and lifestyle changes like abstaining from alcohol. Due to his condition, consultation with nutrition, gastroenterology, nephrology, neurology, and infectious disease services was recommended. Immunization against common liver pathogens and lifestyle modifications were also advised to prevent further damage and support recovery.

1. A CASE PRESENTATIONA CASE PRESENTATION
OF ALCOHOLIC LIVEROF ALCOHOLIC LIVER
DISEASEDISEASE
BYBY
HASHIM SYED ALI ABBAS HUSSAINIHASHIM SYED ALI ABBAS HUSSAINI
PHARM.D V YEARPHARM.D V YEAR
..

2. {{
M MMUHUHUIHM MMUHUHUIH
Gender:
Age:
Admitted
date:
Male
55 years
C/O Yellow discoloration of skin, less urination ,swelling of body
O/E Conscious, oriented , icterus, mild pedel edema
PMH Jaundice since 1 month
SH Married, farmer, alcoholic since 3 years , smoker
date 1 2 3 4 5 6 7 8 9
pulse 80 89 88
BP(mm
hg)
110/
70
120/8
0
120/8

3. HematologyHematology
TEST RESU
LT
N. VALUES
Fasting 95 70-110 mg/dl
Postprandial 140mg/dl
Serum urea 20-50 mg/dl
Serum creatine 0.9 0.9-1.3 mg/dl
Serum uric acid 3.5-7.2 mg/dl
Total
cholesterol
Up to 200
mg/dl
HDL 30-60 mg/dl
LDL Up to 100 mg/dl
Total bilurubin 31.77 0.3-1.2 mg/dl
Direct
bilurubin
21 0-0.2 mg/dl
Indirect
bilurubin
10 0.3-1.0 mg/dl
SGOT 226 Up to 35 IU/L
SGPT 74 Up to 45 IU/L
Na 132 136-145 meq/l
K+ 3.6 3.5-4.5 meq/l
Test RESU
LT
N. VALUES
Hb % 9.2 12-18g/dl
PCV 32-47 %
WBC count 9900 5000-
11000cells/cu.m
m
P 71 40-75 %
L 34 20-50 %
E 0.2 1-6 %
M 2-10 %
Platelet 195000 1.5-4.5
lakhs/cu.mm
ESR 48 0-20 mm/hr
MCV 82-96 cu.mm
MCH 27-32 pg/cell
Bleeding t 1-5 mts

4. Test INFERENCE
albumin 2.6g/dl(3.4-5.2)
globulin 3.6(1.5-3.5g/dl)
USG abdomen Spleenomegaly, portal vein
hypertension
Specific testSpecific test

5. DIAGNOSIS Alcoholic liver disease
TRADE NAME GENERIC NAME DOSE FREQ
Tab. Trental Pentoxifyline 400mg tid
Tab. Pantop Pantoperazole 40 mg Od
Inj vit k 10mg od
Inj thiamin 100 mg Qid
Syp. Duphalac Lactulose 20 ml Qid
Inj hepamer L-ornithine,l aspartate 20ml
Tab. Rifgut rifaximine 400 mg Od

6.  What your body does not need What your body does not need
1. Avoid alcohol.1. Avoid alcohol.
2. Avoid foods that contain trans fat. Trans Fat must be 0 grams.2. Avoid foods that contain trans fat. Trans Fat must be 0 grams.
3. Reduce Sodium intake! No more pretzels , chips, popcorn, french3. Reduce Sodium intake! No more pretzels , chips, popcorn, french
fries, cheese, certain meats, soy saucefries, cheese, certain meats, soy sauce
 WHAT TO TAKE:WHAT TO TAKE: 1. Eat foods high in potassium to offset salt1. Eat foods high in potassium to offset salt
intake. Bananas, Kiwi, apricots, raisins, tomato puree, baked orintake. Bananas, Kiwi, apricots, raisins, tomato puree, baked or
roasted potatoes, veal and nuts, will all assist in ridding the body ofroasted potatoes, veal and nuts, will all assist in ridding the body of
excess sodium.excess sodium.
2. Enjoy light to moderate physical activity, such as walking,2. Enjoy light to moderate physical activity, such as walking,
swimming, gardeningswimming, gardening
3.Build up slowly to 30 to 60 minutes of activity, at least 4 times a3.Build up slowly to 30 to 60 minutes of activity, at least 4 times a
week.week.
4. Avoid food poisoning by storing and preparing foods safely. Wash4. Avoid food poisoning by storing and preparing foods safely. Wash
your hands often.your hands often.
5. Talk to your health care provider if depression affects your ability to5. Talk to your health care provider if depression affects your ability to
eat welleat well..
PREVENTION(LIFE STYLE MODIFICAION)PREVENTION(LIFE STYLE MODIFICAION)

7.  Chew on Fennel Seeds throughout the day (not to exceed 1 tsp!) toChew on Fennel Seeds throughout the day (not to exceed 1 tsp!) to
unclog the liver. Add Turmeric to your meals . It is become a wellunclog the liver. Add Turmeric to your meals . It is become a well
known spice in the medicinal world that whose powerful nutrientsknown spice in the medicinal world that whose powerful nutrients
are known for healing organs.are known for healing organs.
 CarbohydratesCarbohydrates(grains, fruits and vegetables)(grains, fruits and vegetables)
 Fat Fat Healthy oils such as: Extra Virgin Olive, Canola oil, AvocadoHealthy oils such as: Extra Virgin Olive, Canola oil, Avocado
and Smart Balance oils. Omega 3, 6 reduces the inflammation in theand Smart Balance oils. Omega 3, 6 reduces the inflammation in the
liver: Fish, Walnuts, Flaxseedliver: Fish, Walnuts, Flaxseed
 Protein:Protein: Fish (3 x’s / wk), Poultry, Lean Meat Fish (3 x’s / wk), Poultry, Lean Meat
 Salt, canned and processed foods must be limited.Salt, canned and processed foods must be limited.
 Focus on Focus on lower saturated fat choiceslower saturated fat choices with each meal. with each meal.
 Drink 6 to 8 glasses of fluids every day.Drink 6 to 8 glasses of fluids every day.
..

8.  Nutrition services and gastroenterology/hepatologyNutrition services and gastroenterology/hepatology
Adequate nutritional support is of paramount importance for the survival and recoveryAdequate nutritional support is of paramount importance for the survival and recovery
of patients with alcoholic hepatitisof patients with alcoholic hepatitis
 NephrologyNephrology
The onset of acute renal failure may indicate the development of hepatorenal syndromeThe onset of acute renal failure may indicate the development of hepatorenal syndrome
or, alternatively, an episode of acute tubular necrosis resulting either from the use ofor, alternatively, an episode of acute tubular necrosis resulting either from the use of
nephrotoxic drugs or from acute intravascular volume changesnephrotoxic drugs or from acute intravascular volume changes
 NeurologyNeurology
If a patient with alcoholic hepatitis exhibits mental status changes, focal neurologicIf a patient with alcoholic hepatitis exhibits mental status changes, focal neurologic
findings, or seizures, consider consultation with a neurologist.findings, or seizures, consider consultation with a neurologist.
 Infectious diseaseInfectious disease
The fever and leukocytosis that accompany alcoholic hepatitis often raise concernsThe fever and leukocytosis that accompany alcoholic hepatitis often raise concerns
regarding possible sepsis or other infectious processesregarding possible sepsis or other infectious processes
 Immunizing patients with alcoholic liver disease against common infectiousImmunizing patients with alcoholic liver disease against common infectious
pathogens, including hepatitis A virus, hepatitis B virus, pneumococci, andpathogens, including hepatitis A virus, hepatitis B virus, pneumococci, and
influenza A virus, is prudentinfluenza A virus, is prudent..
Follow up:Follow up:

9. THANKTHANK
YOUYOU
..

10. THANKTHANK
YOUYOU
..