Mr. Kitara Isaac, a 45-year-old male with a history of hypertension, presents with hematemesis and jaundice, having previously been hospitalized for similar complaints. He is diagnosed with liver periportal fibrosis due to schistosomiasis and complicated portal hypertension resulting in esophageal varices. The management plan includes addressing patient concerns, medication like propanolol, and advising for immediate medical attention if symptoms persist.

1. PATIENT
PRESENTATION
BY;
NABISERE VIVIAN MBCHB III
DATE;16/11/2023
MINI ROUND CHAIRMAN ;PROF KAGIMU MAJID

2. PATIENT WITH THE DISEASE
4. FAMILY HISTORY
● Mr. Kitara Isaac is a 45 year old male, a muganda by tribe
● He is an unmarried man, Cohabits with his girlfriend, Nabuth Olivia
and a father of 5 children.
● His father, Namutale Charles is alive, but his mother, Namutebi
Christine, died of unknown illness.
● He is the 8th born of 13 children; 3 of his siblings died of Malaria,
others are alive and Healthy.
● He reports no history of any familial illnesses.

3. 5.SOCIAL AND OCCUPATIONAL HISTORY
●Mr. Kitara Lives in a 4-bedroom house in Mukono.
●He is a small scale farmer ( rears some cows and grows some crops) who works near Ggaba. He
stopped in Primary Seven.
●Knows that living and working near lake contributed to his illness.
●Concerned that he cannot leave because it's his place of work.
●Failure to work because of illness
●He is a practicing Anglican, and His financial support is from himself and his friends. His best
friend is Mr. Bakayana.
●His fears are failure to heal death and he reported no enemies.
●He watches football and plays ludo in his leisure time.
●History of 20 years of alcohol intake (one bottle a week): but stopped. No history of smoking.

4. DISEASE OF THE PATIENT
1.PRESENTING COMPLAINTS
● Hematemesis for 1 day
● Yellowing of eyes for 2 days

5. 2.HISTORY OF PRESENTING COMPLAINTS
●The patient complains of of one episode of vomiting a mugful of blood in one
day.
●This was associated with odynophagia and dysphagia while eating and yellowing
of eyes for 2 days that occurred several days before hematemesis. He also
reported low appetite for 2 weeks and chills for 3days.
●He doesn't know the color of stool.
●However, there was no abdominal pain, no significant weight loss, no
constipation or diarrhea, and no abdominal distention.

6. REVIEW OF OTHER SYSTEMS
● Remarkable findings include:
● Increased thirst, dizziness on walking long distances for 1 week,
headaches on overthinking.
● Palpitations, easily gets tired and swelling of feet on walking long
distances.
● However, he reported no night sweats, no change in urine colour, no
abnormal discharges, no mental confusion.

7. 3.Past medical history
● Known hypertensive on unknown medication with no history of other
chronic illnesses.
● Within the past one month, previously admitted in Nsambya Hospital
for one day for similar complaints,
● later admitted in Kiruddu for a week, transfusion of 5 units of blood and
discharged with improvement.
● He reported use of Herbal medicine for ulcers.
● He had a traumatic road accident in 2016 where he almost lost his foot.

8. EXAMINATION FINDINGS
●GENERAL EXAMINATION
●A sick looking adult male, well nourished, and no dehydration with fine hair,
conjuctival pallor. No jaundice, no finger clubbing, no cyanosis and no
lymphadenopathy.
Temp: 36.7 °C
●Pulse rate;111bpm Respiratory rate; 18 breaths per minute
●SPO2; 100
●B.P: 127/77 mmHg

9. ABDOMINAL EXAMINATION
●On inspection; well rounded abdomen, moving with
respiration.
●On palpation; Nothing remarkable
●On percussion; nothing significant
●On Auscultation; Bowel sounds were present.

10. INVESTIGATIONS
●Upper GI ENDOSCOPY
● Complete Blood Count
Results
Endoscopy findings/dx
Medium sized esophageal varices seen.

11. DIAGNOSIS
●Liver periportal fibrosis secondary to Schistosomiasis,
complicated portal hypertension with bleeding esophageal
varices.

12. MANAGEMENT
Managing the patient with the disease
●Give information to the patient about the disease
●Address the concerns of the patient
●Share understanding of the doctors plan ,investigations,
management and monitoring plan with the patient.
●Share decision making with the patient.
●Encourage prayer.

13. Management plan
Managing the disease of the patient
●Fluids??
●Blood??
●Give propanolol
●Variceal banding

14. MONITORING PLAN
●To advise the patient to seek medical attention as soon as possible if the symptoms persist in order to
be able to monitor his symptoms.

15. THE END
THANK YOU