Recomendados
Recomendados
Más contenido relacionado
La actualidad más candente
La actualidad más candente (20)
Similar a Chronic Liver Disease(pediatrics)
Similar a Chronic Liver Disease(pediatrics) (20)
Más de Manoj Ghoda
Más de Manoj Ghoda (15)
Último
Último (20)
Chronic Liver Disease(pediatrics)
- 1. Presented by : Dr Sonita Trivedi Pg teacher : Dr Aasheeta S Shah HOD Paediatrics V S General Hospital Moderator : Dr Aabha Nagral Jaslok Hospital & Research centre
- 2. 11 year old boy, presented with large volume hematemesis Oedema feet and abdominal distension for 2 months Born of a non consanguineous marriage BMI of 28 On examination, pulse rate 120/min, blood pressure 84/50 mm Hg Pallor+, oedema feet++, mild icterus and moderate ascites present, liver just palpable, spleen +4 cm
- 3. Investigation Patient value Normal values Hb 7.1 >12 TC 4800 4000-12000 Platelet count 1,00,000 1.5-4.5 lakh Serum Bilirubin : Total 3 <1 Serum bilirubin: Direct 1.5 0-0.3 Serum Albumin 2.6 3.5-5 Serum globulin 4.5 2-3.5 INR 2.2 0.9-1.1 AST 210 0-35 ALT 140 0-35 ALP 380 Upto 130 GGT 110 Upto 85
- 4. Nodular liver with coarse echotexture Liver span 15 cm Splenomegaly 15 cm Leinorenal collaterals Moderate ascites Ascites tapped Protein 2 g/dl, albumin 0.8, cell count 200, N 40, L 60, ADA -15
- 5. Supportive – fluids, blood, antibiotics Endoscopic measures Pharmacotherapy Prophylaxis of variceal bleed
- 6. Upper GI scopy Large esophageal varices with red colour signs Band ligation done, mild portal hypertensive gastropathy
- 7. Chronic liver disease (cirrhosis) with portal hypertension Likely etiology: Viral hepatitis (Hep B & C) Wilson’s disease Autoimmune hepatitis Non-alcoholic fatty liver disease
- 8. Approach to ascites SAAG (serum ascitic albumin gradient) > 1.1 < 1.1 Peritoneal TB Ascites in cirrhosis, BCS Cardiac High cell count Predom lymphocytes ADA > 33 High LDH Malignant ascites High cell count Malignant cells +ve High LDH Bile ascites Fluid Bil> serum Bil Nephrotic ascites Protein < 2.5 Secondary Bacterial Peritonitis Multiple organisms Total protein > 1 gm Low LDH U/L Glucose < 50 mg/dl Pancreatic Ascites Amylase >1000 Ascitic fluid protein > 2.5 g/dl Transudate/exudate
- 9. HBsAg -ve AntiHCV -ve ANA -ve Other autoimmune markers LKM1 and Antismooth muscle antibody negative Serum ceruloplasmin 15 mg/dl (20-60) 24 hr urine copper 75 mcg in 24 hrs post d-penicillamine challenge, 24 hr urine copper: 340 mcg in 24 hrs Lipid profile –normal and blood sugars normal
- 11. KF rings Serum ceruloplasmin Serum copper 24 hr urinary copper Post Pencillamine challenge 24 hr urinary copper Liver copper stain and quantification MRI brain NO SINGLE TEST CAN BE CONSIDERED A GOLD STANDARD FOR DIAGNOSIS
- 12. D-penicillamine * Zinc Trinetene Zinc + d-penicillamine
- 13. 24 hour Urine copper Complete blood count 24 hour Urine protein Free copper?
- 14. High Protein Diet Vaccination – Hepatitits A,B High Salt Diet NSAIDs Benzodiazepines Aminoglycosides ACE inhibitors Hepatotoxic drugs with caution Contrast agents with caution