A 24-year-old pregnant woman presented with weakness, tiredness, abdominal pain, nausea, and leg swelling for the past 10 days. Examination found pallor, abdominal distension, and leg edema. Tests showed anemia, hypoalbuminemia, and signs of liver cirrhosis. She was referred for further evaluation of suspected liver cirrhosis in pregnancy. The working diagnosis was liver cirrhosis, hypoalbuminemia, ascites, and anemia in the third trimester of pregnancy. Treatment included IV fluids, medications, albumin transfusion, and further ultrasound exams.

1. Afriani/Female/24 yo/FW 15
Chief Complaint:
• Weak and tired since 10 days ago
Present Illness History
• Weak and tired increased since 10 days ago
• The patient started to feel weak and tired since a month ago
• Looked pale
• Pain in the upper abdomen since a week ago, the patient started to feel
pain since 5 months ago and sometimes feel heartburn
• Nausea and vomit sometimes
• Swollen on both legs since 10 days ago
• No fever
• No shortness of breath or cough
• Patient was referred from M Natsir Hosp with susp Liver Cirrhosis for
further diagnosis and therapy
• Had USG Abdomen with the result Mild Hepatomegaly cb susp Hepatitis
dd Liver Cirrhosis, Ascites, and Cystitis
• Had blood transfusion for 3 bags
• The patient is currently having first pregnant with last menstruated in
January 16th 2023

2. • Hypertension (-)
• History of DM (-)
Past illness history
• The patient doesn’t consume any drugs
drug history

3. VII
• General Appearance : Moderate
• Consciousness level: CMC
• BP : 98/70 mmHg
• HR : 98 x/minute
• RR : 19 x/minute
• T : 36.5º C
• SpO2 : 96 %
Physical Examination

4. VII
• Eye
–conjunctiva anemic (+/+), icteric sclera (-/-), isochoric pupil
• Neck
–JVP 5-2 cmH20,
• Lung:
–Inspection: statically & dynamically symmetric, no cicatrix found
–Palpation: fremitus tactile right = left normal ,crepitation -
–Percussion: sonor both of lung
–Auscultation: vesicular +/+, Rh -/- Wh -/-
• Cor:
–Inspection: ictus cordis is not seen
–Palpation: ictus is palpated ric V lmcs ,1 finger medial
–Percussion:
• Left border: 1 finger medial LMCS ICS v
• Right border: linea sternalis dextra iv
• Upper border: ICS II linea parasternalis sinistra
–Auscultation: s1-2,regular, murmur (-), gallop-

5. VII
• Abdomen:
–Inspection: enlargement +, collateral vein -, caput medusae -
–Auscultation: bowel sound (+) N
–Palpation:, Epigastric Pain + hypochondriaca dextra +, liver and
Speen are not palpable, Fundus Uteri 2 fingers upper umbilicus
–Percussion: tympani
• Extremities:
Oedema +/+, CRT< 2 sec, left leg have a reddnes , warm and pain

6. VII
Laboratory
Items Value
Hb 9.6 gr/dl
Ht 30%
Leukosit 10.760/mm3
Platelet 220.000/mm3
Alb/glo 1.9/2.9
MCV/MCH/MCHC 77/25/32
Ur/cr 2/0.2
SGOT/PT 16/8
BT/BD/BI 1.2/1/0.2
GDS 92
Na/K/Cl 139/3.6/110
HbsAg/Anti HCV/ Anti HIV NR/NR/NR

7. VII
ECG

8. Problems
- Ascites
- Oedem
- Hypoalbuminemia
- Susp Liver Cirrhosis in Pregnancy

9. Working Diagnosis
• Susp Liver Cirrhosis
• Hypoalbuminemia cb Low Intake
• Ascites cb Hypoalbuminemia
• Mild Anemia Normocytic Normochrome cb Chronic Disease
• Gravid 25-26 weeks

10. Therapy
• Rest/ Regular Diet
• IVFD: NaCl 0.9% /8 h
• Inj Ranitidine 2x1 amp
• Vit B6 1x1 tab
• Paracetamol 3x500mg
• Inj Dexamethasone 2x2amp
• Albumin Transfusion 25% continued with 20%

11. Plan
- Abdomen Ultrasound
- Fetomaternal Ultrasound
- Check fetal heart rate