case presentation ALD with its complication.

1. CASE STUDY
Alcoholic hepatitis /?cirrhosis /portal
hypertension/ascites/bleeding varies /acute
pancreatitis
Submitted By-
Tanushka
1339215
Department of Pharmacy Practice
ISF College of Pharmacy, Moga 142001, Punjab,
INDIA

2. Patient details-
oNAME- XYZ
oAge- 39 years
oSEX- Male
oDOA- 23 june 2016
oUNIT- medicine 3
oWeight -48 kg

3. Reason for admission- subjective
cont
Patient came with C/O –
Abdomen distension for the past 28 days
Abdomen pain -28days
Vomiting 5 days
Hematemesis one episode today morning
K/C/O-COPD for the past 10-19 yrs on reaction with
METERED dose inhaler
Decrease appetite
H/o constipation and melena (passing back colour
stools) –past from 28 days

4. Family and Personal history -
Family history – not significant
Personal history –
Chronic smoker -19 yrs of age
Chronic heavy alcoholic-19 yrs of age
H/O of heroin addiction for the past 10 years

5. On Examination-
Pt. calm, conscious and oriented to t/p/p.
BP-80/50mmhg
Pulse -70/min
RR-20/min
Temperature 98
.
F
R/S –B/l , decrease VBS in b/l infras capsule region no added sound
Abdomen-
Distension+ve
liver span 14 cm
liver palpable 10-11 cm below the RCM ,tender
Flank dullness +ve
Shifting dullness+ve
Bowel sound +ve

6. objective -22/7/2016
u/s Abdomen
fatty liver with echogenic
SOLS –haemangiomas
Ascites with b/l pleural effusion
23/7/2016
Constituents Detected values
SGOT 1809 IU/L
SGPT 1401 IU/L
ALP 148 IU/L
Sr bilirubin 3.8 mg/dl
Urea 70 meq/l
Protein 5
Albumin 3
Globulin 2

7. 23/9/2016CT scan of abdominal with pelvic:-
Gross ascites
Afew well defined in homogenous enhancing hypodense lesion in rgt
lobes of liver possibility of benign lesion appear likely
visualized thorax reveals bilateral moderate pleural effusion.
Afew well-defined inhomogeneous enhancing hypodense lesion in rgt
lobe of liver, possibility of benign lesion appear likely.
Large bowel loops
24/9/2016
Constituents Detected values Normal range
Lipase 234IU/L <190 IU/L
SERUM amylase 88 IU/L 85 IU/L

8. K/C/O –COPD{10-19 yrs of age} /heroin
addict [10 yr of age]
SUBJECTIVE
• Abdominal distension
• Abdominal pain 28
• Constipation days
• Passing black color stool
• Vomiting 5 days
• Hematemesis one
episode today
OBJECTIVE
• Pallor +ve
• Ct scan- gross asites
large bowel loops .Benign
lesion appear
• SGOT-1809
• SGPT-1401
• ALP-148
• Lipase -234IU/L
• SERUM amylase -88 IU/L
• Urine analysis present of
protein albumin globulin

9. Assessment
• As per the subjective and objective data patient was
diagnosed with alcoholic hepatitis with cirrhosis /portal
hypertension /ascites /shortness of breath/ bleeding
varies/acute pancreatitis k/c/o –copd
• Indication for therapy
Abdominal distension
Sgot, sgpt, alkaline phosphate
Albumin globulin
lipase

10. GOALS
Patient specific
Abdominal pain
Constipation
Passing black color stool
Vomiting
Hematemesis one episode today
Disease specific
To bring the liver function parameter in normal range
Abdominal distension
Hematemesis

11. Drug Name Dose Route Freq D-1 D2 D-3 D4 D5
Inj.omeprazole 40 mg I.V OD / / / Bd Sto
p
inj.drotaverine 20 mg I.V SOS / / / STO
P
Inj.vitamin k3 I.V OD / / / STO
P
Syp.duphalac 30 ml orally TDS / / /
FROM day 6 few drugs are added
Drug Dose Route freq Day 6 Day
7
Day 8
Tab spironolactone 25 mg oral OD / / /
Tab chlordiazepoxide 10 mg oral HS / / /
Tab. torsemide 10 mg Oral OD / / /
Cap omeprazole 20 mg Oral BD / / /
Tab.ademetionine 400 mg oral Bd / / /

12. d1 D 2 D 3 D 4 D 5 D 6 D 7 D 8
BP 100/70
mmhg
90/50
mmhg
80/50
mmhg
90/50
mmhg
90/70
mmhg
100/60
mmhg
90/50
mmhg
100/70
mmhg
PULSE 70 70 76 82 82 74 68 78
RR 20 22 20 20 22 22 20 22
TEMP 98 98.2 98.4 98.2 98 98.6 98.4 98.1
I/O
chart
1600/70
0
2350/12
50
700/135 1500/11
00
Progress chart

13. Pharmacist intervention
• Drug interection-
• chlordiazepoxide+ omeprazole – omeprazole increase the
pharmacologic effect and serum level of certain
benzodiazepine .
Management – observed sleep
• chlordiazepoxide+ torsemide- additive effect on blood
pressure and orthostasis develop hypotension
• Omeprazole +torsemide - hypomagnesium

14. Patient councelling
• ALD refers to liver damage caused by excess alcohol
intake. Alcoholics are at an increased risk for
gastrointestinal disorders, heart diseases and high blood
pressure. Excessive alcohol use can also cause peptic
ulcers, aggression, anxiety and depression.
• portal hypertension may also develop a build-up of fluid in
their abdomen (tummy) and around the intestines. This
fluid is known as ascites

15. • Complete abstinence from alcohol is the cornerstone in the
treatment of alcoholic liver disease. alcohol treatment
programs should be routine in the management of patients
with alcoholic liver disease
• Life style modification -Smoking: Cigarette smoking is an
independent risk factore for cirrhosis in ALD. Avoid oilly or
junk food,
• Nutritional supplement improves hepatic function, and
outcome in AH
• Patients consuming > 3000kcal/d had virtually no mortality,
• Whereas those consuming <1000 kcal/d had > 80% 6-
month mortality
• Medication: How to take, When to take, How long to take,
Storage conditions. Proper medication adherence