hepatitis case

05/03/2023 1

MEDICO-SOCIAL CASE ON HEPATITIS

Presented by: Dr. Kunal

Guided By: Dr. Abhay Mudey

05/03/2023 2

Name: Sarika Raju Janjal

Age- 21 years, Sex: Female

Religion: Hindu, Cast: Kunbi (OBC)

Address: Ward No-1, Near Mahadev Mandir, Peth Raghunathpur, Mangrul Dastagigir Taliuka, Amarawati-444711

Date of admission : 16/05/2016

Date of Examination : 17/05/2016

Admitted in : Ward No-27, Medicine Ward

Bed No: 14

GENERAL INFORMATION

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SOCIO ECONOMIC HISTORY

Education : 10th Pass

Occupation : Homemaker

Total annual Family income: Rs.50,000/-(From all sources)

Total No. of family member in the house : 4

Per Capita Income per month : Rs. 1041/capita/month

Socio economic status : According to Modified B.G Prasad’s Classification – Class IV

05/03/2023 4

CHIEF COMPLAINTS

Patient came to hospital on 16th of May 2016, with chief complaints of ;

1) Vomiting 3 episodes X 2days

2) Loose Stools 3 episodes X 2 days

3) Abdominal Pain X 2 days

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H/O PRESENT ILLNESS

Patient was apparently alright 2 days back, when she had vomiting 3episodes in evening on 15th may after taking meal , the vomiting was non projectile, containing food particles & water, without any presence of blood in vomitus, no foul smell.

She complains of loose stools containing semi digested food particles & water without any presence of blood in stool it was mainly watery & non mucoid in appearance.

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CONTINUED

Patient also complains of abdominal pain with 1st episode of vomiting in the epigastric region, it was spasmodic type of pain, non radiating.

H/O Patient visiting to her mothers place about 2 weeks back.

No H/O fever / cough.

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PAST HISTORY

No similar complaints in the past.

History of contact : absent

No H/O blood transfusion, hypertension, Diabetes Mellitus, Asthma, Any chronic illness, or surgery.

No H/O of substance abuse.

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PERSONAL HISTORY

Vegeterian diet

Appetite reduced

Bladder habits : Normal

Yellow colour of urine

Bowel Frequency of passing stools increased- 3 episodes

Loose motions for 2 days

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FAMILY HISTORY

Family consist of 4 members.

She lives with her husband & Mother in law, Brother in law.

No history of similar complaints in family.

No history of any chronic illness/DM/HTN/Asthma in the family.

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FAMILY COMPOSITION

Name Relation Age Education

Occupation

Raju Husband 27 10th Pass Mason (Cement Mistry)

Sarika Self 21 10th Pass Homemaker

Gayabai Mother in law

46 Illiterate Homemaker

Ranjeet Brother in law

22 12th Pass Farmer

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MENSTRUAL HISTORY

Normal Regular/ 28 days

4-5 days cycle

No dysmenorrhoea

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DIETARY HISTORY

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Dietary history

CALORIES (Kcal) PROTEIN (gms)

MORNING:

TEA (1 CUP) ≈ 62 ≈ 1.0LUNCH:CHAPATI (2) ≈ 180 (2 x 90) ≈ 3.0 (2 x 1.5)DAL (1 KATORI) ≈ 75 ≈ 3.1VEGETABLE (1 KATORI) ≈ 150 ≈ 1.7RICE (1 KATORI) ≈105 ≈ 2.1EVENING:TEA (1 CUP) ≈ 62 ≈ 1.0 DINNER:CHAPATI (2) ≈ 180 (2X90) ≈ 3.0 (2X1.5)DAL (1 KATORI) ≈ 75 ≈ 3.1RICE (1 KATORI) ≈105 ≈ 2.1VEGETABLE (1 KATORI) ≈ 150 ≈ 1.7TOTAL ≈ 1144 ≈ 21.8

05/03/2023 14

CONTINUED….

Energy requirement is ≈2230 kcal.

Energy deficit is ≈ 1086 kcal

Protein requirement is ≈ 37 gms

Protein deficit is ≈ 15.2 gms

05/03/2023 15

ENVIRONMENTAL HISTORY

Stays in kuccha house, roofed with tin sheet.

3 rooms in house.

Each room has 1 room & 1 door.

Separate kitchen.

Toilet bathroom attached.

Tap water from gram panchayat used for drinking & other purpose.

Do not filter or boil drinking water.

05/03/2023 16

CONTINUED….

Drinking water is stored in earthen pot (Matka) with lid & every time gadu is used to take water from pot.

Garbage disposal in open field near the house.

Sullage disposal in open kuccha drain beside the house.

Fly nuisance present.

No pets at home.

05/03/2023 17

TREATMENT HISTORY

Inj. Pan 40 IV od

Inj. Emset 4mg IV od

Inj. D-25% IV od

IVF. D-25% 500ml slow IV tds

IVF. DNS O II IV stat

IVF. RL O II IV stat

Tab. UDILIVE tds

05/03/2023 18

GENERAL EXAMINATION

Patient is cooperative, oriented to time, place & person.

Patient is afebrile.

Pulse : 64 /min

Blood Pressure : 110/60 mmHg

Respiratory rate : 17/ min

Height- 4 feet 8 inches (i.e 146.3 cm).

Weight-37 kg

05/03/2023 19

CONTINUED….

BMI : 18.29

Pallor : Present

Icterus : Present

Lymph nodes : Absent

Clubbing : Absent

Oedema : Absent

05/03/2023 20

SYSTEMIC EXAMINATION

Abdominal Examination : Inspection :-

Abdomen scaphoid shape

Normally moving with respiration.

Umbilicus inverted & centrally placed.

No scar, No visible veins are present.

Skin is dry.

05/03/2023 21

CONTINUED….

Palpation :-Abdomen soft,

Non tender,

Liver firm smooth with distinct border.

Palpable measuring about 2 fingers (2.5cm) from the lower costal margin.

Spleen is non palpable

05/03/2023 22

CONTINUED….

Percussion :-Normal tympanic note heard.

Shifting dullness absent.

Auscultation :-

Normal bowel sound heard.

05/03/2023 23

CONTINUED….

Respiratory System :-Air entry equal on both sides.

No additional sounds heard.

CVS: S1 S2 heard, No murmur.

05/03/2023 24

CONTINUED….

CNS:-Patient well oriented to time place & person.

No neurological deficit found .

05/03/2023 25

CASE SUMMARY

21 year old female Sarika Raju Janjal, belonging to socio economic status class IV, living in kuccha house, with 2 rooms and does not boil & purify drinking water by any means, was admitted with complaints of vomiting, loose motions, pain in abdomen since 2 days & was under treatment as suspected case of viral hepatitis.

05/03/2023 26

DIFFERENTIAL DIAGNOSIS

Liver Cirrhosis

Cholangitis

Liver Abscess

Hepatocellular Carcinoma

05/03/2023 27

PROVISIONAL DIAGNOSIS

21 year old female, Sarika Raju Janjal with mild dehydration suspected to be a case of Viral Hepatitis.

05/03/2023 28

INVESTIGATIONS

Hb% : 9.8

WBC : 7,100

Total Protein : 6.5

Albumin : 3.7

Globulin : 3.8

Total Albumin : 21.26

Direct albumin : 8.37

Indirect : 12.89

05/03/2023 29

CONTINUED….

Prothrombin time : 139

Alkaline Phosphatase : 310

Serum Creatinine : 0.56

Sodium : 142

Potasium : 4.3

05/03/2023 30

CONTINUED….

Liver function test :

SGOT : 160 UI/lit

SGPT : 180 UI/lit

RBS : 78 mg/dl

Stool Examination :

Viral particles are seen under electron microscopy.

05/03/2023 31

CONTINUED….

Urine examination for bile & Bile salts.

USG :-

Borderline hepatomegaly with liver parenchymal disease.

05/03/2023 32

TREATMENT & FOLLOW UP AT INDIVIDUAL LEVEL

Tab Norflox TZ BD X 3D

Tab Buscopan SOS

ORT & High Oral fluids adviced.

Tab Pan D BD X 3D

Tab.UDILIVE TDS X 15 D

05/03/2023 33

TREATMENT ADVICE & FOLLOW UP AT FAMILY

LEVEL

Advice Preventive measures Hand washing Cleaning of foods Purification of water Disinfection of water

05/03/2023 34

TREATMENT ADVICE ,FOLLOW UP AT

COMMUNITY LEVEL

Health education Mass Media approach

Breaking channel of transmission by constructing SANITATION BARRIER.

Protection of susceptible by Immunization.

05/03/2023 35

RECOMMENDATIONS

Hand washing

Food hygiene

Avoiding food from street vendors

05/03/2023 36

THANK YOU