A case presentation on

alcoholic liver disease

Reg .No.14Q1001
PATIENT DEMOGRAPHIC DETAILS

• NAME :-XYZ
• AGE :- 60years
• GENDER :- male
• UNIT :- medicine d
• DATE OF ADMISSION :- 13-11-2018
• DATE OF DISCHARGE :-19-11-2018
COMPLAINTS ON ADMISSION :-

>C/O abdominal distension since 3 days.

>C/O yellowish urine colour since 1 week
>C/O generalized weakness
>C/O yellowish discoloration of white of eye
>C/O swelling of both the limbs
• SOCIAL HISTORY:-
Diet :- mixed
Appetite :- decreased
Sleep :- disturbed

• chronic alcoholic since 10 yrs,1 bottle/day,chronic smoker 10 cigarattes/day

PHYSICAL EXAMINATION:-
• GENERAL :-B.P. – 120/76 mmHg
PR – 76 bpm
CVS :- S1 S2 +ve, no murmer
RS :- NVBS heard
CNS:-NAD
 SOAP ANALYSIS FOR ALOHOLIC LIVER
DISEASE
SUBJECTIVE EVIDENCE

C/O abdominal distension since 3 days.

C/O yellowish urine colour since 1 week
C/O generalized weakness
C/O swelling of both the limbs
C/O yellow discoloration of white of the eye
OBJECTIVE EVIDENCE

• Known alcoholic
LAB DATA :-
• Bilirubin total:-2.5 mg/dl(0.3-1.0 mg/dl)
• Bilirubin direct:-1.4 mg/dl (0-0.4 mg/dl)
• AST:-193 (8-42 IU/L)
• ALT:-56 (3-30 IU/L)
• Albumin:-2.4(3.5-5.2 g/dl)
• Moderate ascites with anterior abdominal wall edema
ASSESSMENT

• From subjective and objective evidence it was diagnosed as Alcoholic

liver disease.
THERAPEUTIC GOALS

Patient specific:-
To reduce the complaints of abdominal distension and lower limb
swelling.

Disease specific:-
To prevent the further progression of disease.
 ASSESSMENT ON CURRENT THERAPY
DRUGS DOSE ROUTE FRE. 1 2 3 4 5 6 7

GENERC NAME BRAND NAME

Tab. Spironolactone T. Aldactone 25 mg PO 1-1-0 + + + + + + +

Tab. Silymarin T. Silimar 140 mg PO 0-1-0 + + + + + + +

Syp. Lactulose Syp. Duphalac 100 ml PO 1-1-1 + + + + + + +

Tab. Furosemide T. Lasix 40 mg PO 1-0-0 + + + + + + +

 PROGRESS CHART
DAYS PROGRESS

DAY 1 C/O Abdominal distension B.P. 126/78 mmHg,PR-72bpm

DAY2 C/O abdominal distension PR 76bpm, B.P. 128/80mmHg

DAY3 C/O abdominal distension B.P. 130/86mmHg, P.R 76bpm

DAY4 C/O abdominal distension B.P- 126/80mmHg. PR - 78bpm.

DAY 5 B.P-128/86mmHg. PR – 80 bpm.

DAY 6 B.P-130/86mmHg. PR – 76 bpm.

DAY 7 C/O abdominal distension reduced B.P- 126/80mmHg. PR - 78bpm. Patients feels better.
PLANNING

• Tab. Silymarin 70mg 1-0-1 for 1week

• Tab. Spiranolactone 25mg 1-1-0 1week
• Syp. Lactulose 100ml 1-1-1 for 1week.
 TOXICITY PARAMETERS

• SPIRONOLACTONE
• Drowsiness,headache,mental
confussion,rash,gynecomastia,diarrhoea,vomiting
• SILYBIN
• Abdominal pain,allergic reaction,nausea,pruritus
• LACTULOSE
• Dehydration,hypokalemia,excessive bowel activity
• FUROSEMIDE
• Anaemia,anorexia,dizziness,hypocalcemia,hypotension
PATIENT COUNSELLING

DISEASE SPECIFIC:-
• Advice the patient to stop using alcohol completely
• An alcohol rehabilitation program or counselling may be necessary to
break alcohol addiction
• Eat plenty of fruits and vegetables to ensure that you get plenty of
nutrients.
• It difficult to fight off infections so be sure you wash your
hands frequently.
• Many drugs are filtered through the liver, so consult your
health care provider before taking any medications. You
should avoid taking aspirin, naproxen and ibuprofen.
• Ask the patient to reduce the intake of carbohydrates
containing food like potato,bread,etc.
• Ask the patient to avoid fat content food like meat,oils,etc.
DRUG SPECIFIC:-
Spirinolactone
• Patient should not drink alcohol while taking this drug
• Advice patient to avoid potassium supplements and food / salt
substitutes that are high in potassium.
THANK YOU