Retro viral disease with chronic liver disease with portal hypertension with upper GI BLEEDING with severe anemia

1. RVD +VE
WITH CHRONIC LIVER DISEASE
WITH PORTAL HYPERTENSION
WITH UPPER GI BLEED SEVERE ANEMIA
PRESENTED BY,
YASHWANTH.N.B
REG.NO-21Q0899
II PHARM.D
S.E.T’S COLLEGE OF PHARMACY
DHARWAD

2.  INTRODUCTION :
 RETRO VIRAL DISEASE (RVD):
RVD is a chronic immune system disease caused by the human
immunodeficiency virus (HIV).
HIV damages the immune system and interferes with the body’s ability to fight
infection and disease. There’s no cure for HIV/AIDS, but medications can control
the infection and prevent disease progression.
 CHRONIC LIVER DISEASE :
Chronic liver disease in the clinical context is a disease process of the liver
that involves a process of progressive destruction and regeneration of the liver .
parenchyma leading to fibrosis and cirrhosis
• PORTAL HYPERTENSION:
Portal hypertension is elevated blood pressure in your portal vein and the smaller veins

3. • UPPER GI BLEEDING :
Upper gastrointestinal (GI) bleeding is defined as hemorrhage
from the mouth to the ligament of Treitz.
• SEVERE ANAEMIA :
Anemia is a condition in which the body does not have enough healthy
red blood cells. Red blood cells provide oxygen to body tissues.

4.  CLINICAL PRESENTATION :
 SIGNS AND SYMPTOMS
 RETRO VIRAL DISEASE
- Headache.
- Fatigue.
- Aching muscles.
- Sore throat.
- Swollen lymph nodes.
- A red rash that doesn’t itch, usually on your torso.
 DIAGNOSTIC TEST
antibody tests, antigen/antibody tests, and nucleic acid tests (NATs)

5. • CHRONIC LIVER DISEASE :
SIGNS AND SYMPTOMS
1. Skin and eyes that appear yellowish (jaundice)
2. Abdominal pain and swelling.
3. Swelling in the legs and ankles.
4. Itchy skin.
5. Dark urine color.
6. Pale stool color.
7. Chronic fatigue.
8. Nausea or vomiting.
DIAGNOSTIC TESTS :
Blood test, Urine test, kidney function test

6.  SUBJECTIVE :
 CHIEF COMPLAINTS
A 40 Year old Male patient was admitted in hospital with IP no. 202337306 on 06 JUNE 2023
with chief complaints of Ascites, Breathlessness from. 3days K/C/O RVD Positive
 VITAL SIGNS : BP = 130/80mmHg , PR = 86bpm , RR =18cpm , SPO2 = 98%
 PAST MEDICAL HISTORY : HIV POSITIVE ON ART
 PAST MEDICATION HISTORY : ART MEDICATIONS ( Abacavir,Tenofovir,Emtricitabine)
 ALLERGIES : none
 SOCIAL HISTORY : Alcohol consumption 18 years

7.  OBJECTIVE :
TEST RESULT NORMAL VALUE
Urea 29 10-45mg/dl
Creatinine 1 0.5-1.5mg/dl
Uric acid 6.9 3-7.5mg/dl
Sodium 129 135-145m.mol/l
Potassium 36.3 37-54fL
Total protein 6.2 6-8g/dl
Bilirubin Total 0.9 0.1-1.2mg/dl
GRBS 104 70-160 mg/dl
SGOT 55 Upto 37 U/L
Alkaline Phosphatase 196 40-170U/L
RBC 2.40 4-5.5×10^3 cells/cumm
HB 6.3 12-16g/dl
WBC 13.2 ×10^3 cells 4-11×10^3 cells/cumm
SGPT 26 Upto 40 U/L

8.  ASSESSMENT :
DAYS PROGRESSION MEDICATIONS
DAY-1
BP = 126/78mmHg
PR = 86bpm
RR = 16cpm
SPO2 = 95%
Inj. Pipzo
T. Rifagut
T. Udiliv
Inj. Pantop
Inj. Thiamine
Syp.lactulose
Inj. Lasix
Inj.vitamin k
GRBS Monitoring
Whole blood transfusion
Continued ART
DAY-2
BP = 100/80mmHg
PR = 95bpm
RR = 18cpm
SPO2 = 96%
BP is decreased CST

9. DAY-3
BP = 120/80mmHg
PR = 92bpm
RR = 18cpm
SPO2 = 98%
BP Increased CST

10. BRAND
NAME
GENERIC
NAME
DOSE ROA FREQUENCY DAYS
OF
RX
INDICATION
Inj.PIPZO Piperacillin and
tazobactum
4.5g IV TID 3 Helps To Prevent Blood
Clot
T. RIFAGUT Rifamixin 550mg PO BID 3 Antibiotic to treat
hepatic encephalopathy
T. UDILIV Ursodeoxycholic
acid
300mg PO BID 3 Biliary agent to dissolve
gall stones
T. PANTOP Pantoprazole 40mg PO OD 3 GERD treatment
Inj.THIAMINE Thiamine HCL 100mg IV TID 3 Vitamin supplement
Syp.LACTULOSE Enulose 30ml PO OD 3 Reduces amount of NH3
in CLD patients
Inj.LASIX Furosemide 20mg IV BID 3 Edema
WHOLE BLOOD
TEANSFUSION
IV - 2 Life-threatening
hemorrhage where
oxygen-carrying capacity,
coagulation factors,
platelets and are needed
Continue ART
- - - - 3 Antiretroviral medicines
that are often used to
treat HIV include:

11. ADVERSE DRUG EFFECTS :
• Inj.Pipzo: nausea, constipation, diarrhoea, headache, and trouble sleeping
• T.Rifagut: headache, peripheral oedema (leg swelling), nausea, dizziness, fatigue,
ascites
. T.UDILIV: nausea, vomiting, diarrhoea, and jaundice.
• T.PANTOP: Blurred vision, dry mouth,increase hunger
• Inj.Thiamine: Feeling tired , stomach ache
• Inj.Lasix: muscle cramps, weakness, unusual tiredness

12.  MONITORING PARAMETERS :
 DRUG MONITORING
 PIPZO: Periodic monitoring of your blood cell count is recommended
 Syp.Lactulose: abdominal distention, presence of bowel sounds, and
normal pattern of bowel function
 Inj.Lasix: Monitor daily weight, intake and output ratios, amount and
location of edema, lung sounds, skin turgor, and mucous membranes

13.  PATIENT COUNSELLING OF DISEASE :
⚫CHRONIC LIVER DISEASE :
is a slowly progressing disease in which healthy liver tissue is replaced with scar
tissue, eventually preventing the liver from functioning properly. The scar tissue blocks the flow
of blood through the liver and slows the processing of nutrients, hormones, drugs, and naturally
produced toxins.
⚫PORTAL HYPERTENSION:
is an increase in the blood pressure within a system of veins called the
portal venous system. Veins coming from the stomach, intestine, spleen, and pancreas merge into
the portal vein, which then branches into smaller vessels and travels through the liver.

14.  PATIENT COUNSELLING OF DRUG :
 RIFAGUT: You can take it with or without food.
 UDILIV: may be taken after a meal.
 PANTOP:Swallow tablets whole with a drink of water
 Syp.LACTULOSE: mix your dose with half a glass or water or fruit juice

15.  PREVENTION :
1. Avoid drinking alcohol.
2. Eat a balanced diet.
3. Avoid raw seafood, raw fish, and shellfish.
4. Discuss the appropriate amount of protein you need to eat
5. Maintain physical activity

16. THANK
YOU