A case of 31 yr old male with CLD and PORTAL HYPERTENSION

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
Yellowish discolouration of sclera since 4 days
Indigestion and tightness of abdomen since 4 days
Pt was apparently asymptomatic 2 yrs back,then he developed pain abdomen for which he went to hospital and diagnosed with fatty liver relieved with medication
1 yr back pt developed pedal edema,jaundice and abdominal tightness and anasarca 3 times in a year for which he underwent paracentesis 3 times
H/o jaundice 4 to 5 times in a span of 2 yrs
H/o hemetemesis 4 to 5 times per day
H/0 malena
2 months back 1 episode/ day hemetemesis 
For which he admitted in NIMS for 1 week and discharged
Pt developed hypopigmented lesions over both upper limbs and back and itching was their,4 months back then he using ointmemt for that
Not a k/c/o Dm ,HTN ,Asthma,TB,CVD
ALCOHOLIC-180ml / day since 10 yrs
General examination 
Pt was conscious coherent cooperative
No pallor cyanosis clubbing lymphadenopathy and edema 
Icterus+
Temp: 98.2F
BP: 110/80   mmHg
PR: 104 bpm
RS:20 cpm
GRBS: 152 mg/dl
CVS: s1s2+
Rs: BAE+
P/A  soft non tender
Distended abdomen
Clinical images


Ecg
Chest x ray 



USG
1)Hepatomegaly with altered echotexture of liver
2)Chronic thrombosis of extrahepatic portion of portal vein with portal recanalisation
3)Multiple periportal ,perisplenic,peripancreatic collaterals noted
2D ECHO
EF 62 %
No RWMA,good LV  systolic function
No diastolic dysfunction
Hemogram
HB: 7.3
TLC :9600
PLT: 1.97 lakhs
PT :18 secs
INR: 1.33
ApTT 35 sec 
BGT AB +ve
RBS 108
B urea 12
Creat 0.7 
LFT ON 29/5/22

Provisional diagnosis
CHRONIC LIVER DISEASE WITH PORTAL HYPERTENSION with NORMOCHROMIC NORMOCTYTIC ANEMIA WITH HYPOALBUMINEMIA ? TINEA
TREATMENT
1)TAB  LASIX 40 mg/BD
2)TAB ALDACTONE 50 mg /BD
3)TAB UDILIV 300 mg po /BD
4)Syrp LACTULOSE 20 ml po /TID


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