CASE PRESENTATION ON

DECOMPENSATED LIVER DISEASE

M.RAJI PRISCILLA
PHARM.D 4th YEAR
12T51T0017
CHIEF COMPLAINT
• Mr. B.A.R. is 55 years of male, arrived with a
chief complaint of abdominal pain and
swelling since 2 months.
SUBJECTIVE DATA
• History of present illness : Pedal edema
• History of past illness :Nil
• Past surgical history : Nil
• Personal history : Alcoholic
• Past medication history: Nil
• Family history : No similar
complaints.
OBJECTIVE DATA
• Allergies : Not known drug allergies

• Physical examination:
(a) General appearance
* Height – 158
* Weight – 65 kgs
* B.M.I. – kg/m.sq(over weight)
(b) Vital signs
* Pulse – 74 beats/min
* Respiratory rate – 18 breaths/min
* B.P – 120/70 mm hg
• Head to toe examination :
*Skin –none
*Head – none
*ENT – none
*Neck – none
*lungs- p/l normal vesicular breath sounds
*Abdomen –free fluid(+),dullness(+)
*Cardiovascular – S1+S2+Mo
*Musculoskeletal/neurological –none
• Local examination : patient conscious,
pallor(+),icterus(+)
lymphadenopath, edema pitting type
• Lab tests: blood examination
Parameter Observed value Normal value
examined
TWBC 5000 6000-16000 micro

Neutrophils 78 50-70 %

Lymphocytes 16 20-50

Monocytes 01 2-10
Parameter Observed value Normal value
examined
Hb 5.6 13-18gm%

Prothombin time 21.8 10-15sec

S.cr 2.0 0.6-1.4

S.k+ 2.9 3.5-5.5meq/dl

T.bilirubin 19.1 0.2-1.2mg/dl

Direct bilirubin 9 0.1-0.4mg/dl

SGOT 151 5-45IU/L

• Diagnostic test: ELISA test-6.76(+)
• Sonograph evaluation:
Hepatomegaly
Hepatic parenchymal disease
Portal hypertension
 Diagnosis:

• DECOMPENSATED LIVER DISEASE(HCV+VE)

CIRRHOSIS
 MEDICATION
Medication given Route of admin. Frequency

Duphalac(lactulose) Oral OD

Monocef IV BD

Tramadol IV OD

UDELIV ORAL OD

TELIPRESSIN IV 6hrly

RIFAXIMINE ORAL BD

PANTOCID iIV BD
Drug name Dose Indications Drug Adverse effects
interactions
DUPHALAC 30ml To prevent No significant Bloating,stomachp
complications reactions ain,nausea
among drugs
prescribed
MONOCEF 1gm Antibiotic No Nausea,vomiting,di
arrhoea
TRAMADOL 2mg Pain reliever No Pruritis,constipatio
n,hallucination
UDELIV 150mg Primary biliary No Urination
cirrhosis frequency,jointpain

TELIPRESSIN 1amp To decrease No chest

B.P,hepatorenal pain,abnormal
syndrome heart rhythm
RIFAXIMINE 550g To reduce risk of No
encephalopathy
PANTOCID 1amp Antacid No Headache,abdomin
al pain
 ASSESMENT
• Cirrhosis is a condition in which the liver does not function properly due
to long-term damage. Typically, the disease comes on slowly over months
or years. Early on, there are often no symptoms. As the disease worsens, a
person may become tired, weak, itchy, have swelling in the lower legs,
develop yellow skin, bruise easily, have fluid build up in the abdomen, or
develop spider-like blood vessels on the skin. The fluid build-up in the
abdomen may become spontaneously infected. Other complications
include hepatic encephalopathy, bleeding from dilated veins in the
esophagus or dilated stomach veins, and liver cancer. Hepatic
encephalopathy results in confusion and possibly unconsciousness
Prevention
Key prevention strategies for cirrhosis and its compensation are population-wide
interventions to reduce alcohol intake (through pricing strategies, public health
campaigns and personal counseling), programs to reduce the transmission of viral
hepatitis, and screening of relatives of people with hereditary liver diseases.
Little is known on modulators of cirrhosis risk and progression. Coffee consumption
appears to help protect against cirrhosis.

Warnings
People who suffer from decompensated liver failure must monitor their condition closely.
Seek immediate medical attention for new or continued abdominal pain, fever, shortness
of breath, rapid swelling in the body or decreased urination. Friends or family members
should bring loved ones to a medical professional right away if they notice increased
sleeping, agitation, confusion or drowsiness.
THANK YOU