A case of chronic hepatitisB

A CASE OF CHRONIC HEPATITIS B : 

A CASE OF CHRONIC HEPATITIS B Dr H.GANESH HOD,Dept. of Medicine ESIHospital,KKNagar,Chennai

Patient Details : 

Patient Details ARAVIND KUMAR 25Y MALE SINGLE DOVisit in OPD: 9/1/07

PRESENTING COMPLAINTS : 

PRESENTING COMPLAINTS EPISTAXIS: 3 EPISODES IN 3 WEEKS

HOPI : 

HOPI Presented in ENT OPD with h/o BLEEDING FROM NOSE on 3 occasions in the preceeding 3 weeks:once each 3weeks ,2 days& 1day back. Also c/o intense itching all over the body for last 1wk Also elicited c/o dragging pain in left upper abdomen for 3 months & h/o jaundice in childhood

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ENT EXAM..:CSOM RT EAR SCRATCH MARKS ON SKIN AROUND NOSE,CONGESTED NASAL MUCOSA WITH NO ACTIVE BLEED

Suspectng obstructive jaundice, : 

Suspectng obstructive jaundice, ENT IMO ordered LFT,PT/APTT,HGM,BT/CT Found Serum ALP,APTT-increased & platelets mildly decreased Referred to Med. OPD

Med IMO : 

Med IMO Confirmed the findings & also demonstrated moderate splenomegaly Suspecting liver disease , repeat LFT,S.Proteins,USG ABD.,P.Smear ordered Revealed :increased ALP(654 U-{N:<350}),increased S.Glob{3.8g},mild thrombocytopenia,moderate splenomegaly and altered liver echos. Cofirmed the suspicion Medical Specialist opinion sought

Medical specialist : 

Medical specialist Confirmed the findings already elicited by Medical &ENT IMOs Details regarding past h/o jaundice elaborated:pt suffered multiple injuries at the age of 2years for which he received 4 units of blood.3 years later he suffered jaundice with uneventful recovery with native medicine. Similar episodes of jaundice occurred 3-4 times in childhood In 2003 he had another episode of jaundice ,he was thoroughly investigated in SRMC:Biliubin,SGOT,SGPT(ALT) were raised,splenomegaly &coarse liver echos in USG

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Grade 1,2,3 oesophageal varices &gastric varices in OGD were demonstrated. In addition,positive HBsAg&HBeAg and negativeAnti HBeAb were established. Diagnosed as decompensatedLD,CAH B.He was advised lamivudine,propranolol,aldactone.Pt discontinued Rx afer 1-2 months on his own. He has now presented here after 4years

summary : 

summary Presented now with Epistaxis,gen.itching,pain left upper abdomen Past h/o repeated jaundice ,h/o blood transfusion, Established as CAHB with Cirrhosis/Portal HT in2003 ,did not take prescribed antiviral Rx Non alcoholic,unmarried ,denies sexual relationship

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Following signifcant findings in this visit No jaundice,pedal edema;Scratch marks present all over body No palmer erythema,whitenails,spider Mod splemomegaly,no ascites/hepatomegaly KF ring suspected but ruled out by Ophthalmologist GOH

INVESTIGATIONS (This visit) : 

INVESTIGATIONS (This visit) LFT:B-1.6/0.85 OT/PT/ALP-34/24/654 PT:14/13 APTT:55/32 Hgm;10.5/9800/P65L32/ Plat.:95000 S.Pr:7.49=A3.65+G3.84 LFT:B-1.3/0.85 OT/PT/ALP-34/24/604 PT:14/13 APTT:55/32 Hgm;10.5/9800/P65L32/ Plat.:95000

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USG:Moderate splenomegaly,coarse liver echos,no ascites PS:mild thrombopenia S.Im: A:4.5(0.7-4.0G) G:21.4(7-16G) M:2.5(0.4-2.3G) E:117(12-87 IU) HBsAg:Positive

DIAGNOSIS&RX : 

DIAGNOSIS&RX Chr.Hep.B-Cholestatic phase,Cirrhosis/Portal HT Propranolol 20mg bd,aldactone 25 tds,Inj Vit K 1amp X 3days KF Ring was suspected by our ophthalmologist.Pt was in cholestatic phase.Therefore,Medical GE Consult was sought.

MEDICAL GE : 

MEDICAL GE Confimed our findings . INESTIGATIONS,PROCEDURES,CONSULTS by MEDICAL GE: LFT:2.2=0.9+1.2 117/129/457 S.Pr=6.1g=A3.2g+G2.9g USG:Altered liver echos,mod splenomegaly(20X10cm)

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OGD:Grade 1,2,3 Oesophageal varices,congestive gastropathy HBsAg:Positive AntiHCV Ab:Negative EYE Consult (GOH): NoKFRing Hemat. Consult:WNL(Hb 12,PCV45.TC4800,DC:P58L38E7,PL:1.45L,PS:Normal)

Diagnosis : 

Diagnosis Diagnosis :HBV Related Decompensated LD with Cirrhosis/ Portal HT Asked for HBeAg,Anti HBeAb,HBV DNA (Quantitative) HBV DNA-4282 IU equivalent to33796 copies(3.8-2,5000.000IU; 1 IU=7Copies)

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HBeAg,AntiHBeAb-NA AntiHBc total:Positive AntiHBc IGM:4(0-10 U)

TREATMENT ADV : 

TREATMENT ADV Lamivudine-100mg od Aldactone 25mg 2od Propronolol 20mg bd Liv 52 :1tds Rantac-1bd BC-1bd

Recommendations in brief : 

Recommendations in brief 6 DRUGS APPROVED FOR CAHB HBV DNA LOAD increasingly used to stage disease Rx to be given even in decompensated LD/cirrhosis Screening for HCC regularly HAV Vaccine in indicated patients&routine screening for Hepatitis C