Clinical case

Presented by: Alaa kablawi

Rani jubran
Dia mahamid
Bodur abu zkika
Donia salti
Group:1444
 General data
Patients’ name: Valeanu maria
Age:69
Born in:23.2.1950
Admitted:25.6.2019
 Complains
She was admitted to the hospital in 25.6.2019 with
complains of:
-loss of appetite
-loss of weight 15 kg in the last year
-pain in the RUQ and RLQ and supraumbilical
Pain syndrome: appeared 2 wks ago,prior admission
to hospital.Pain is located in the RUQ abdominal
region and radiating to the back,and worsening at
night.

Dyspeptic syndrome: suffering from loss of

appetite,which led to an unusual weight loss of 15
kg in the past year.
 History
In 1990,the patient was admitted to the hospital with
symptoms of:
fatigue,sudden nausea and vomiting.
Abdominal pain and discomfort
Loss of appetite,low-grade fever

She was diagnosed with liver disease in the past.

In 2015-2017 she had a stroke.
In 2015 she had grade III AHT,reaching up to
200mm/Hg,and was treated with lisinopril and bisoprolol.
In 2018,she had a cholecystectomy operation.
Physical examination
General inspection

*bilateral presented hard callus formation at the carpal region proximal to the
index finger.
*Swan neck toe on left foot *Hard callus on the right dorsal region of
the foot
*trophical changes in the skin and Varicose veins on the soleus
region of the right leg,covering 2/3 of the leg
Respiratory system

-On auscultation:Normal Vesicular breathing

-RR 18/min
-on percussion: resonance

CVS

-Inspection:no palpitation or chest deformity

-palpation:normal apex beat
-percussion: Cardiac dullness without limits deviation
-Auscultation:no heartm murmurs,72 bpm
-Arterial pressure 130/80
Digestive system

-inspection:white-yellow deposits on the tongue

Red spots spreaded all over the abdomen
-palpation: pain in right epigastric region and right
hypochondrium,and slight pain in the
supra-umbilical region.
palpable liver mass in its right lobe,and
palpable spleen.
-percussion:increase liver borders[R-21cm]
[L-8.5cm]
Presumptive Dx
Chronic liver disease, hepatitis or cirrhosis

Right hemiparesis due to ischemic cerebral stroke

back in 2015 .
Plan of investigations
Lab test
Biochemical parameter
Cholestatic :- GGT, ALP, albumin
Cytolytic :- ALT/AST
Hepatosuppressive :- albumin , PT
Immunoinflammatory
Serological markers for hepatitis , B, C, D
Grade of fibrosis by fibroscan, or liver biopsy
Ultrasound
Lab Analysis
Thrombocytes 124 150-400 10*9/L

Total protein 84.10 64-83 g/L

ALT 74.20 0-55

AST 110.30 5-46

Direct bilirubin 11.10 0-8.6

IgG 42.73 5.4-18.22 g/L

PT 64 70-120%

PTT 1.5 0.7-1.3

Albumin 27.9 36-52
 Diagnosis
Chronic hepatitis,with co-infection of HBV and
HDV
 Tx
For HBV : antiviral drugs- entecavir, adefovir,
Lifelong
Interferon alpha

For HDV : interferon alpha { peg-IFN alpha }, more

than one year