51 yr old male with yellowish discoloration of eyes and urine

 This is an online E log book to discuss our patient's de-identified health data shared after taking his/her/guardian's signed informed consent. 

Here we discuss our individual patient's problems through series of inputs from available global online community of experts with an aim to solve those patient's clinical problems with collective current best evidence based inputs. 

This E log book also reflects my patient-centered online learning portfolio and your valuable inputs on the comment box is welcome. 

Case presentation:

51 year old  male who works at petrol station, resident of  Narketpally Presented with fever since 1 week ( lasted for 2 hrs)

 yellowish discoloration of eyes and urine since 4 days 

Patient was apparently asymptomatic 2yrs back later he developed swelling of both sided small and large joints ( multiple joints) for which he was diagnosed with rheumatoid arthritis and diabetes ,for which he prescribed prednisolone 10 mg , HCQ - 200mg , lefloreamide 2 mg , daily for 2 yrs 

Metformin 500mg OD for 1 nd half years and glimi 1 mg + metformin 500 mg OD since 6 months 


Then he developed fever 1 episode 1 week back lasted for 2 hrs  then yellowish discoloration of eyes and urine since 4 days 

H/o of pale stools

No h/o of loose stools 

No mucous and blood in stools 

No h/o itching 


Past h/o

K/c/o of DM since 2 yrs and on Glimi 1mg + metformin 500mg since 6 months

K/c/o R.A ( on DMARDS) 2 Yrs 

Not a k/c/o HTN , Asthma , TB ,CVA,CAD , epilepsy

K/c/o alcoholic occasionally for 10 yrs

Not a smoker


O/e:

Pt is c/c/c

No pallor 

Icterus present 





No cyanosis 

No clubbing , lymphadenopathy 

Afebrile to touch

Ecchymosis  present in right cubital fossa 



PR:80bpm

BP:130/80 mmhg

Spo2:96

RR : 20bpm


P/A:

Inspection : 

Shape of abdomen : obese 



No scars , sinuses 

Palpation: 

No tenderness , no organomegaly .

Liver span - 7cm 

RS:B/LAE+,nvbs

CVS:s1,s2+,no murmurs

CNS:no FND


Investigations at admission

FBS



PLBS 



HBA1C



ECG 





CHEST XRAY 



LFT 



RFT 




HbsAg:  Positive 


USG


BT,CT,INR



DIAGNOSIS

Acute viral hepatitis secondary to HbsAg

With k/c/o DM TY2 With k/c/o RA ( on DMARDS since 2yrs

)


Rx on the day of admission 

1.TAB PANTOP 40 mg /OD

2.SYP HEPAMERZ 15 ML BD

3.SYP LACTULOSE 15ML H/S , STOP IF >2 EPISODES OF LOOSE STOOLS

4.TAB UDILIV 300MG BD

5.TAB GLIMI 1 - M1 - OD ( 8AM)

6.TAB TENOFOVIR 25MG 

7. GRBS 6TH HOURLY PRE MEAL 

8.BP / PR/ TEMP MONITORING

TODAYS LFT



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