A 60-year old male patient presented with complaints of yellowish skin discoloration, swelling in the lower legs, constipation, abdominal distension, and fatigue. He had a history of alcohol use for 8 years and smoking for 12 years. Laboratory tests showed elevated bilirubin levels and liver enzymes. An ultrasound revealed a fatty liver with surface nodules. He was diagnosed with alcoholic liver disease and treated with medications, lifestyle counseling, and advised to abstain from alcohol and smoking. His symptoms improved over three days of treatment and he was discharged.

1. ALCOHOLIC LIVER DISEASE
CASE PRESENTATION ON
HAMMAD KC
4TH PHARM.D

3. Demographics
 Name : XYZ
 IP NO: IPID0062630
 Date of admission: 20/06/2019
 Date of discharge : 24/06/2019
 Department: gastroenterology (GW 4rd floor)
 Sex: Male
 Age: 60 yrs
 Weight: 82 kg

4. 1.SUBJECTIVE EVIDENCES
 Chief complaints on admission
 Patient have complaints of yellowish discoloration of skin, swelling in
both lower leg
 c/o hard stool and fatigue
 c/o abdominal distention
 Past medical history : k/c/o Depression , Asthma

5.  Social history
 Appetite : Decreased
 Bowel and bladder : Decreased frequency
 Habits : smoker (1-3 cigarette per day) since 12 years
Alcoholic since 8 years ( 40 – 50 ml of whiskey)
 Physical examination : A 60 year old male patient was conscious ,
oriented and alert to time, place and surroundings.
PEDAL EDEMA

6. 2.OBJECTIVE EVIDENCES
 Systemic examination
 CNS : conscious and oriented
 Per abdomen : Distended
 Vital signs
 BP : 130/80mmHg
 PR : 80 bpm

7. INVESTIGATION TEST VALUE NORMAL VALUE
Hb 10.2 13-18 g/dl
TLC 9700 4000-10000 cells/cu.mm
ESR 18 0-20 mm/hr
Direct bilirubin 4.2 0-0.2 mg/dl
Indirect bilirubin 4 0.3 – 1.0 mg/dl
SGOT 126 Up to 35 IU/L
SGPT 72 Up to 45 IU/L
PT 27 11 - 15.8 sec
LABORATORYDATA

8.  Radiographic data
 USG abdomen : Fatty liver with nodules on surface of liver

9. 3.ASSESSMENT
Subjective evidences Objective evidences
Yellow discoloration of skin
swelling in both lower leg
Constipation and abdominal distension
Fatigue
Alcoholic since 8 years
Smoker since 12 years
Hb 
D.Billirubin and indirect bilirubin Serum ↑
SGOT , SGPT ↑
USG Abdomen : fatty liver
Based on subjective evidences & objective evidences patient is diagnosed to have
ALCOHOLIC LIVER DISEASE

10. 4.PLANNING
 To reduce liver injury due to excessive alcohol use
 To prevent progression of disease
 To reduce symptom
 To prevent complication
 To reduce need of hospitalisation

11. DRUG TREATMENT CHART
BRAND NAME GENERIC NAME DOSE & FREQUENCY D1 D2 D3
T.TRENTAL Pentoxifylline 400mg 1-1-1 Day 1 - 3
Inj .VIT.K Vitamin k 10 mg 0 -1 -0 Day 1 - 3
Inj.THIAMINE HCL Thiamine HCl (vit B1) 100mg 1- 0 - 0 Day 1- 2
Inj.HEPA MERZ L- Ornithine, L- Aspartate 5gm 1 -1- 0 Day 1 - 2
T.RIFAGUT Rifaximine 400 mg 1-1-0 Day 1 - 3
T.LASIX Furosemide 40 mg 1 – 1 - 0 Day 1 - 3
SYP. DUPHALAC Lactulose 20 ml 1- 1 -1 Day 1 - 3

12. Progress chart
DAY 1 Patient admitted with complaints of yellowish
discolouration of skin swelling in both lower leg
abdominal distention etc..and was diagnosed with
ALD
DAY 2 No fresh complaints seen
BP : 120/80mmhg Pulse rate : 89 bpm
DAY 3 Patient improved symptomatically
Requested for discharge
BP: 120/80 mmHg PR : 88bpm

13. Goal achieved
 reduce liver injury due to excessive alcohol use reduced
 Disease progression prevented
 Signs and symptoms improved
 Patient quality of life improved

14.  Suggestion to physician
 Monitor BP regularly : co administration of furoximide and pentoxifylline causes
reduction in blood pressure

15. Advice to patient
 Disease related
 ALD : Liver is a large organ playing major role in metabolism , when a
person drinks alcohol heavily over a long period of time body start to
replace the healthy tissues of liver to non healthy tissues or scar tissues
As the disease progress and more of your healthy tissue is replaced by
scar tissue your liver will stop functioning properly

16. Pharmacotherapy related
 Adherence to drugs is very important for the control of symptoms.
 Drugs have to be taken at correct dose & frequency as advised by the
physician.
 If any dose is missed then don’t take extra medicine to make up the
missed dose.
 If any side effects occur, approach the physician.

17.  Lifestyle modification
• Abstinence of alcohol consumption and smocking
• Take healthy nutritional food like green vegetables, fruits.
• Avoid excess intake of fatty foods like oil, meat, dairy products like butter,
cheese etc.
• Enjoy light to moderate physical activity such as walking , swimming ,
gardening.
• Manage body weight.
• Avoid food poisoning