A 42-year-old male presented with complaints of bloating, abdominal pain, nosebleeds, and breathlessness. He has a history of chronic alcoholism and perianal hematomas. Examination found moderate general condition with normal vital signs. Labs showed elevated liver enzymes, low hemoglobin and platelets, indicating alcoholic liver disease with portal hypertension and anemia. Ultrasound showed an enlarged liver with portal hypertension and mild ascites. He was assessed with alcoholic liver disease due to excess alcohol intake. Treatment included antibiotics, antiemetics, pantoprazole, vitamin K, and thiamine to reduce complications and improve quality of life. Lifestyle changes including a fiber-rich diet and avoiding alcohol

1. ALD WITH PORTAL
HYPERTENSION
WITH ANAEMIA

2. SUBJECTIVE
DATA
A 42 y/o male comes to the
hospital with chief
complaints of:
Bloating( since 3 days)
Abdominal pain(since 6
days)
Bleeding through nose
Breathlessness

3. OBJECTIVE
DATA
a. Medical h/o: multiple
episodes of perianal
haematoma
b. Medication h/o: ns
c. Social h/o: chronic
alcoholism since about
10y
d. Family h/o: ns

4. Physical
Examination
 General condition- Moderate
 HEENT- Normal
 CVS- S1,S2 + no murmur
 RS - AEEBS clear
 CNS - conscious, oriented
 P/A- S,NT
 BP- 110/90 mm Hg
 PR- 86/min
 RR- 18/min

5. D.Bil: 0.2
T.Bil: 0.9
Creatinine:
1.9 mgs%
(0.5-
1.5mgs%)
Urea: 34
T.Pr: 6.9
ALP: 110
(44-150
IU/L)
LAB INVESTIGATION
AST: 56u/L(10-40u/L)
ALT: 70u/L(7-56u/L)

6. HAEMATOLOGY
• WBC 1.4x 10³/uL
• LYM 24%
• MXD 5.6%
• NEUT 1x10³/uL
• RBC 2.11x10ⁿ
• Hb 4.8 mg/dL
• MCV 89.6fl
• MCHC 25.4g/dL
• PLT 3x10³/uL

7. USG
SPLEEN
URINARY BLADDER
RK/LK
LIVER
GALL BLADDER
[N] in shape and size,with normal
echotexture
[N] in shape & size, echotexture
with multiple splenic hilar collateral
Moderately enlarged with
parenchymal diffusion and portal
hypertension seen
[N] , minimally distended
E/o mild gross ascitis seen
[N] in shape and size, partially
distented
PANCREAS
[N] , distended , obscured

8. 01
02
ALD is due
to excess
alcohol
intake
Etiology:
03
To reduce morbidity
and mortality.
To prevent further progression of
disease and complications in liver
and it's functioning.
To improve the quality of life.
ASSESSMENT
Goal of the therapy

9. ASSESSMENT TO CURRENT
THERAPY

10. CERAZONE
CEFOPERAZONE SODIUM (2g BDS)
 Broad spectrum antibiotic with high
clinical efficacy
 Indications- RTI,UTI, cholecystitis and
other intra abdominal infections
 Dosage- 1-2g/12 hours.
 Contraindications-Hypersensitivity to
cephalosporin and penicillins
 Side effects- Neutropenia,transient rise
in SGOT,SGPT,ALP, anemia,
 Drug interactions-Potentiates
anticoagulant, disulfiram like reaction
with alcohol.

11. EMESET
ONDANSETRON( 4g i.v TDS)
 Highly selective 5HT3 antagonist
 Indications- vomiting and nausea
 Dosage- 8-16mg/day
 Contraindication- Hypersensitivity
 Adverse reaction- Headache,
constipation,allergy
 Drug interaction- Dexamethasone potentiates
the drug

12. PANTOP
PANTOPRAZOLE (40 mg OD)
 It is a proton pump inhibitor,inhibits H,K ATPase enzyme
which secretes HCl in parietel cells of stomach
 Indications-Ulcers and reflux oesophagiti
 Dosage- 40-80 mg/day
 Contraindication- Hypersensitivity
 Side effects- Headache, diarrhea, dizziness

13. VITAMIN K
VITAMIN K ( Tb. 10g TDS)
 Acts as cofactor at a late stage in synthesis by liver of
coagulation proteins-prothrombin,factors VII,IX & X
 Indications- prophylaxis, treatment of bleeding due to
deficiency of clotting factors, haemorrhage
 Dosage- 10-50 mg/day
 Precautions- Can cause haemolysis in patients with G-6-PD
deficiency and neonates

14. THIAMINE
THIAMINE (1 mg iv OD)
 Forms thiamine pyrophosphate by combination with ATP,
essential coenzyme in carbohydrate metabolism
 Indications- carbohydrate content of diet
is high
 Contraindications- Hypersensitivity
 Adverse effects- Pulmonary edema,
anaphylaxis, restlessness,nausea
 Drug interaction- Azithromycin,
erythromycin

15. PLANNING
Therapeutic monitoring:
SGOT,SGPT, RBC, Bilirubin
Discharge medicine: Patient not
yet discharged

16. Further suggestions
Lifestyle changes
About disease
• Foods rich in fat
should be avoided.
• Fibre rich diet
• Fluid intake to be
increased to avoid
bloating and
constipation
• ALD is due to the
excess alcohol intake
• Portal hypertension
has caused
nosebleeds and
decreased WBC
Intake of alcohol should
be in moderation,
preferably stopped
Regular brisk
walking,yoga and
meditation would be
beneficial.
Diet
Point to patient

17. 2
1 Chronic administration of
thiamine can worsen the
patient's breathlessness.
No drug interactions found .
POINT TO PHYSICIAN

18. 95%
60%
50% 60%
THANK YOU