2. A 40-year-old male NKCM,but the history of iv drug abuser for many years presented to the ER with C/O
severe abdominal pain associated with fever since 3 days
Also history of black or tarry stool (malena) 4 weeks ago
Also c/o anorexia since 10 days.

3. . O/E revealed "track" marks on both arms.
PALE looks skin
Distended abdomen

8. Lab investigations Hb 8.1 Tlc 4.0 Plts 80 MCV 102 Ur 35 Cr 0.65 Na 138K
Chl
Bicarb

9. PT
APTT 42
INR 4
Albumin
ECG Normal
CHEST X .RAY Unremarkable

10. LFTs Bilirubin 2.o D/billi 2.43 ID /billi 1.5
SGPT (serum glutamic-pyruvic transaminase, ALT)
SGOT (serum glutamic-oxaloacetic transaminase ,AST)
ALT PHOSPHTASE
GAMMA GT

11. What is the differential diagnosis of abdominal pain????

12. Acute gastroentiritis
Intestinal obstruction
Appendicits
Renal stone
Viral hepatitis
Liver abcess
Gastric ulcer
Abdominal TB
Malignancy
Acute pancreatitis

13. What is the differential diagnosis of abdominal pain with fever????

14. What is the differential diagnosis of faver?

15. (i) hematemesis vomiting of blood
Bleeding from a lesion in the esophagus,stomach, and duodenum is called upper GI bleed.
(i) hematemesis vomiting of blood
(ii) malena, passage of black tarry stool

16. Causes of upper GI bleed
Esophagitis
Esophageal varices
Mallor_weiss tear
Gastric ulcer
Duodenal ulcer
Ca stomach

17. Mallory-Weiss tear
A Mallory-Weiss tear occurs in the mucus membrane of the lower part of the esophagus or upper part of the stomach, near where they join. The tear may bleed.
Mallory-Weiss tears are usually caused by forceful or long-term vomiting or coughing. They may also be caused by epileptic convulsions.
Any condition that leads to violent and lengthy bouts of coughing or vomiting can cause these tears.

18. Bleeding esophageal varices
Bleeding esophageal varices are enlarged veins in the walls of the lower part of the esophagus that bleed. The esophagus is the tube that connects your throat to your stomach.

19. Causes of oesophageal varices
Pre-hepatic
Portal vein thrombosis.
Portal vein obstruction - congenital atresia/stenosis.
Increased portal blood flow - fistula.
Increased splenic flow.
Intra-hepatic
Cirrhosis due to various causes, including alcoholic, chronic hepatitis (eg viral or autoimmune).
Idiopathic portal hypertension (hepatoportal sclerosis).
Acute hepatitis (especially alcoholic).
Schistosomiasis.
Congenital hepatic fibrosis.
Myelosclerosis.
Post-hepatic
Compression (eg from tumour).
Budd-Chiari syndrome.
Constrictive pericarditis (and rarely right-sided heart failure).

20. Oesophageal varices

21. WHAT FURTHER INVESTIGATIONS YOU WILL ADVISE ON THE BASIS OF THESE LABS??

22. HbsAg
IF +VE THEN GO FOR PCR OF HBV (DNA)
Anti HCV . If +ve , then get PCR for HCV (RNA).
U/S abdomen . Liver status ,shrinkage,any
tumor,margins.

24. There is no vacanation of HCV due to RNA genotype
There is a vacination of HBV due to DNA genotype

27. How many types of viral hepatitis?

28. Hepatitis A
Hepatitis B
Hepatitis C
Hepatitis D
Hepatitis E ( PREGNANCY)

30. Three things for liver function monitoring
LFTs (If LFT derrange specialy SGPT it means liver problem developed)
PT, APTT, INR (if pt ,aptt,INR incresase it means acute liver problem)
Albumin (If Albumin decrease it means with PT,APTT,INR, increase it means chronic liver problem)

31. PCR OF HCV (RNA) POSITIVE OR
PCR OF HBV (DNA) POSITIVE
WITH
Decompensated liver disease
Decompensated liver disease means that the medications and treatments used to treat the liver is no longer working very well and the liver is near total failure
It means only symptomatic treatment

32. IVF
IV Antibiotics (if infections develop)
Diuretics (k sparing diuretics Aldactone)
Antipyretic (if fever spike)

39. Mangement of upper GI Bleed
IV access
Oxygen
Sedation
Blood transfusion
PPI (proton pump inhibitor)
Octreotide (vasopressin)
surgery

41. IF PCR OF HCV (RNA) POSITIVE
WITHOUT DECOMPENSATION
THEN START INJ INTERFERON WITH CAPSULE RIBAVIRIN

42. IF PCR OF HBV (DNA) POSITIVE
WITHOUT DECOMPENSATION
INTERFERON THERAPHY (interferon alpha,peginterferon alfa-2b)
NUCLEOSIDE ANALOGUES (lamivudine tab zeffix 100mg 1 OD , and adefovir 10mg 1.OD)

43. Side effects of interferon theraphy
Thrombocytopenia
Flu like symptoms