CHRONIC

LIVER
DISEASE
 D E M O G R A P H I C D AT A
• Name – Mr.Sandesh

• Age – 53 years

• Gender – Male

• Education – SSLC

• Occupation – Driver

• SES – Class 4 acc to modified BG Prasad classification

• DOA – 28/03/23

• DOE – 04/04/23

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CHIEF COMPLAINTS

• Abdominal distension × 3 weeks

• Yellowish discoloration of eyes × 2 weeks

• B/L swelling of lower limb × 2 weeks

• Two episodes of vomiting of blood 2 days back

H I S TO RY O F P R E S E N T I N G I L L N E S S
• Patient is a known case of Chronic Liver disease since past 3 years

• He was apparently alright 3 weeks back, then he developed abdominal distension

which was insidious in onset, gradually progressed to current state, diffuse in
nature, changed with position, not associated with breathlessness, abdominal
pain
• Yellowish discoloration was noticed by his wife, it was acute in onset and
progressive, a/w high coloured urine, not a/w itching
• Bilateral pedal edema was insidious in onset, initially involved only
feet now involves feet and calf , aggravated on standing and relieved
on resting
• Vomiting of blood was sudden, two episodes, bright red in colour,
non projectile, contained food particles, a/w black tarry stools, not
a/w abdominal pain
No h/o dyspnea, palpitations, cough

No h/o facial puffiness, decreased urine output

No h/o TB infection

No h/o fever, fatigue, generalized weakness

No h/o unintentional weight loss

• No h/o blood transfusion, tattooing

• No h/o altered sleep-wake cycle

 PA S T H I S T O RY
He was diagnosed with Chronic Liver disease 3 years back

He had 3 episodes of similar complaints involving abdominal distension, Yellowish discoloration

and b/l pedal edema

1st episode – 3 years back

2nd episode – 1 year back

3rd episode – 3 months back

He was symptom-free in between the episodes

He had undergone Colonoscopy and paracentesis thrice in past 3 years (last time was on January
17)

Not a known case of hypertension, DM, Asthma, TB

FA M I LY H I S T O R Y
• No similar complaints in family

• No h/o hypertension, DM, TB in the family

P E R S O N A L H I S TO RY
• Mixed diet – predominantly non vegetarian

• Decreased appetite since a week

• Sleep is adequate

• Bowel and bladder habits are regular

• Consumes 2 quarter(360 ml) of Whiskey daily since 20 years

Alcohol unit = 40× 360 = 14.4 units / day

1000
He is a non smoker
S U M M A RY
• Middle aged male with significant alcohol consumption history of 20 years and
known case of Chronic Liver disease since 3 years presented with Ascites since 3
weeks, Jaundice since 2 weeks, bilateral pedal edema since 2 weeks, two
episodes of hematemesis 2 days ago
• PROVISIONAL DIAGNOSIS – Acute on Chronic liver disease with symptoms
suggestive of portal hypertension with probable etiology being chronic alcohol
consumption with other possible differentials including viral hepatitis
G E N E R A L P H Y S I C A L E X A M I N AT I O N
• Patient is conscious, co-operative, well oriented to time, place and person

• He is moderately built

• Vitals – Pulse rate – 102 / min, regular rhythm, normal volume and character

BP – 120/90mmhg in right upper limb in supine position

RR – 17/min predominantly thoracic type

Temp – 98.6 degree Fahrenheit

H E A D T O T O E E X A M I N AT I O N
• Pallor – seen in lower palpebral conjunctiva

• Icterus – seen in upper bulbar conjunctiva, palms and on skin

• Edema – pitting type, grade 2, upto knee

• Cyanosis – absent

• Clubbing – absent

• Lymphadenopathy – absent

• No other signs of liver cell failure are seen

S Y S T E M I C E X A M I N AT I O N
• Per abdomen

• Inspection – Abdomen is uniformly distended, flanks are full

Umbilicus appears horizontally slit

Corresponding quadrants move equally with respiration
Skin appears shiny with no stria or scratches noted.
Engorged veins present over flanks above the level of umbilicus
Scar of previous tapping is seen in right spinoumbilical line
Divarication of recti – absent
Hernial orifice appears normal
• Palpation – On superficial palpation:

No local rise of temperature, non tender

No rigidity or guarding
Abdomen girth – 105cm
Spinoumbilical distance – Right – 21cm, left – 20cm
Xiphoumbilical distance – 23 cm
Umbilicus to pubis – 19cm
Engorged veins fill from below upwards
On deep palpation: No masses felt
• Percussion: Liver – upper border of liver dullness is percussed at right 5 th
intercostal space along midclavicular line and lower border is not palpable
Shifting dullness – absent
Fluid thrill- appreciated
Auscultation: Bowel sounds are heard
No bruit heard over umbilicus and hepatic region
• CNS – no focal neurological deficits

• RS – b/l normal vesicular breath sounds heard

• CVS – S1,S2 heard, no murmur

DIAGNOSIS
• Decompensated liver disease probably Cirrhosis of liver with features of portal
hypertension due to chronic alcohol consumption, anemia probably secondary to
GI blood loss with no features of hepatic encephalopathy and with no other
comorbidities