Bimonthly internal assessment october 7 , 2020

 CASE 1

A1 As per the history given by the patient cirrhosis of the liver maybe the cause of ascites due to chronic alcoholism from 40yrs

A2 Due to decreased synthesis of albumin because of the cirrhosis of liver the oncotic pressure is decreased thereby causing bilateral edema.

A3 The increased levels of ammonia in liver failure patients causes damage to the neurons causing hepatic encephalopathy the reason for asterixis in this patient 

The treatment given is lactulose so that it excretes ammonia 

A4 high protein diet like eggs should be given

Fluid should be restricted 

Antiseptic dressing for the ulcers

Syp lactulose

Slow iv fluids for hydration

INJ thiamine as he is chronic alcoholic

CASE 2

A1 ATT were stopped because of the deranged LFT which maybe due to chronic alcoholism or the hepatotoxic drugs such as isoniazid or rifampicin

A2 Bilateral infiltrations noted in the chest xray 

Consolidations are also seen 

A3 Improper functioning of the liver which causes portal hypertension thereby ascites in this patient

A4 Inj actrapid insulin sc 8am 2pm 8pm for diabetes 

Inj pan iv 

Inj optineuron 

Syp lactulose to prevent hepatic encephalopathy 

Protein powder 2 to 3 spoons in a glass of milk

Two eggs per day for protein supplementation 

Grbs charting

CASE 3 

A1 The treatment for nephrotic syndrome is steroids 

If this is steroid sensitive nephrotic syndrome the patient responds to the drugs

The steroids are started and they are slowly tapered as per the requirement

The cause for nephrotic syndrome maybe primary which is idiopathic or secondary such as

Glomerular pathology,diabetes ,cancer ,drugs ,infections and some congenital diseases

A2 Renal biopsy would be really helpful if the nephrotic syndrome is due to any glomerular pathology 

There are disadvantages to the renal biopsy such as affordability of the patient,time taking,and the post biopsy complications.