This case presentation describes a 26-year old female patient admitted with jaundice. Her symptoms included yellowish discoloration of skin and nails for 7 days, yellowish urine for 3 days, and cough for 4 days. Physical examination revealed yellowish discoloration of skin. Laboratory tests showed elevated bilirubin levels. She was diagnosed with jaundice and treated with antibiotics, IV fluids, antacids, and medications to reduce bile and support blood clotting. She was discharged with medications including analgesics, antacids, vitamins, and an expectorant. The patient was advised to take medications regularly and follow a proper diet.

1. CASE PRESENTATION
BY
RAHMAN KHAN

2. DEMOGRAPHIC DETAILS
• NAME : xyz
• AGE : 26 years GENDER :Female
• DOA : 5/11/2016 DOD : 12/11/2016
• DEPARTMENT : GEN MEDICINE
• I.P NO - 527874
• UNIT : A WARD: MICU

3. SUBJECTIVE EVIDENCE• PRESENT COMPLAIN : c/o yellowish discoloration of skin & nail since 7 days.
• c/o yellowish urine since 3 days & cough since 4 days
• c/o decreased appetite since 1 week.
• HISTORY OF PRESENT ILLNESS : pt. was apparently normal 15 days back then she
developed fever since 4 days which is of low grade continuously present throughout the day
associated with cold & cough insidious onset , non progressive on taking medicine.
• PAST HISTORY : No h/o TB/ASTHMA/EPILEPSY.
• FAMILY HISTORY: nothing significant.
• PERSONAL HISTORY :
• Diet : mixed
• Sleep : normal
• Appetite : decreased
• Bowel & bladder : regular

4. OBJECTIVE EVIDENCE
PHYSICAL EXAMINATIN:
B.P: 110/70 mmHg
PULSE: 78/min
B.TEM: normal
GENERAL EXAMINATION: pt. is conscious and cooperative.
Skin: yellowish discoloration
SYSTEMIC EXAMINATION:
CVS : S1 S2 +ve
Respiratory system : B/L NVBS
Abdominal examination : soft non tender, no organomegaly
CNS : Conscious oriented.
PROVISIONAL DIAGNOSIS: JAUNDICE

5. INVESTIGATION
HAEMOLYTIC EVALUTION:
• HEMOGLOBIN : (13.8-18 gm/dl)-12g/dl
• ESR : (F-0-30mm/hr)- 60 mm/hr
• NEUTROPHIL:(60-70%)- 85%
• LYMPHOCYTE: (22-30)- 25%
• PROTHROMBIN TIME: (11-14sec)- 19 sec
URINE & LFT TEST:
• EPI CELL: 2-3
• PUS CELL: 3-4
• BILE: (0.1-1.0mg/dL) – 9.5mg/dL
• Sr BILE: (upto 0.4mg/dL)- 4.4mg/dL
FINAL DIAGNOSIS: JAUNDICE

6. TREATMENT
drugs Day 1 2 3 4
Inj. CEFITRIAXONE I g I.V √ √ √ √
Ivf DNS RL 10 √ √ √ √
Tab. PARACETAMOL 500mg SOS √ √ √ √
Inj. ONDANSETRON 1amp I.V √ √ √ √
Inj. RABEPRAZOLE 20mg I.M √ √ √ √
INJ URSODESOXY CHOLIC
ACID 1amp I.M
√ √ √ √
Inj.VITAMIN K supp 1 amp √ √ √ √
Syp. AMBROXYL HCL+
SALBUTAMOL
SULPHATE+GUAIPHENESIM
MENTHOL 5ML
√ √ √ √

7. ASSESSMENT OF THERAPY
• INJ CEFTRIAXONE 1g I.V
MOA : it is third generation cephalosporin which are selectively inhibits bacterial cell wall synthesis by
binding to trans peptidases which are penicillin-binding proteins.
SIDE EFFECTS: chest pain,chill,cough,fever,painful urination
• IVF DNS RL (DEXTROSE)
it provide calories and are source of water for hydration.
SIDE EFFECTS: itching, rashes, swelling of the mouth face lips
• TAB PARACETAMOL 500mg
MOA:NSAID’s ANALGESIC
SIDE EFFECTS: skin rashes, itching, diarrhoea, nausea, vomiting
• INJ ONDANSETRON
MOA- It is given to reduce vomiting by blocking emetogenic impulses in the gut and their central rely.
SIDE EFFECTS: confusion, dizziness, fever, headache, weakness
• INJ RABEPRAZOLE
MOA: proton pump inhibitor.it suppresses gastric acid secretion by specific inhibition of hydrogen-
potassium adenosine triphosphates.
SIDE EFFECTS: dark urine, dry mouth, fever, chills, nausea, vomiting.

8. • INJ URSODESOXYCHOLIC ACID
MOA: these drug reduce cholesterol absorption and also relieve itching in intrahepatic cholestasis.
SIDE EFFECT: constipation, headache, back pain, dizziness etc..
• INJ VIT K
MOA- It helps to treat and prevent unusual bleeding by increasing the body’s production of blood clotting
factors.
SIDE EFFECTS: decreased. appetite, difficulty in breathing, enlarge liver etc.
• SYPAMBROXYL HCL+SALBUTAMOL SUPHATE+GUIPHENESIM MENTHOL (EXPECTORANT)
MOA:TERBUTALINE is selective beta2 adrenergic agonist which stimulate beta 2 receptor thus producing
relaxation of bronchial smooth muscle.
AMBROXOL: it promotes the removal of tenacious secretion in the respiratory tract and reduce mucous.

9. DRUG INTRACTION
• No drug interaction were found in these medication.
DISCHARGE MEDICATION:
• Tab. PARACETAMOL 500mg SOS
• Tab ONDANSETRON
• Tab `RABEPRAZOLE 20mg
• Tab URSODESOXY CHOLIC ACID
• Tab VITAMIN K
• Syp. AMBROXYL HCL+ SALBUTAMOL SULPHATE+GUAIPHENESIM MENTHOL 5ML

10. PLANNING
COMMUNICATION WITH THE PATIENT
Medication should be followed regularly .
Proper dose should be taken
Proper diet should be done.
Avoid oily and spicy foods.