Chronic Liver Disease(pediatrics)

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Chronic Liver Disease

Transcript of Chronic Liver Disease(pediatrics)

  • 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
  • 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
  • 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 1.1 < 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
  • 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
  • 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
  • D-penicillamine * Zinc Trinetene Zinc + d-penicillamine
  • 24 hour Urine copper Complete blood count 24 hour Urine protein Free copper?
  • High Protein Diet Vaccination Hepatitits A,B High Salt Diet NSAIDs Benzodiazepines Aminoglycosides ACE inhibitors Hepatotoxic drugs with caution Contrast agents with caution