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Viswesh Velugula
Jan 19, 2021
In Case Discussions
■ Presented with fatigue and anorexia since 3mnths ■ Was evaluated elsewhere and was found to have deranged LFT ■ She resorted to CAMs following which she had yellowish discolouration of eyes and urine associated with intense pruritus ■ Currently pruritus resolved, but jaundice persists ■ No H/o GI bleed/ abdominal distention/ Joint pains/ skin rash On evaluation ■ HB – 11.5 ■ PLATELET – 1.6L ■ S.IgG – 3699 ■ ANA profile – negative ■ Anti LKM1 – negative ■ ASMA – negative ■ AMA – negative ■ ANCA – negative ■ UGI scopy – no varices ■ Fibroscan – CAP- 223, E(kpa) – 46.1 ■ USG abdomen(28/09/20) – Altered and coarse echotexture of liver and caudate lobe hypertrophy ■ Borderline splenomegaly (12.5cms) ■ USG abdomen (16/11/20) – Nodular liver with altered echogenicity and minimal ascites MRCP(02/10/20) Mild altered liver parenchymal signal intensity Mild splenomegaly Normal biliary system ■ Liver biopsy- Marked areas of necrosis with loss of hepatic parenchyma and bile ductular reaction with moderate mixed inflammation – DDs – AIH /IgG4 related sclerosing cholangitis/DILI. ■ She was started on Wysolone 40mg 4weeks ago ■ Currently asymptomatic except for persistent jaundice
49 yrs female with Ulcerative colitis since 3 ½ yrs in remission (last flare 2yrs ago) content media
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Viswesh Velugula
Jan 19, 2021
In Case Discussions
• Presented intermittent pain abdomen a/w abdominal distension, nausea since 6 months • h/o weight loss ~10kg/6m • 2-3 semisolid to liquid stools, uses laxatives, no blood or mucous o/s evaluation Colonoscopy • Terminal ileal stricture at 5 cm from IC valve, scope not negotiable -? IBD – CD / kochs • Bx – non specific ileitis, MTB PCR => Negative MRI enterography • Long segment ileal thickening with luminal narrowing • Ileo vescical fistula • Started on Pentasa and Budez- CR • patient presented to us with abdominal distension and pain , constipation à treated conservatively , passed flatus, stools not passed CBC - 10.2/12200/4.9 S.CREATNINE - 1.0 LFT - 0.5/0.1 ESR - 26 cue - Plenty of pus cells => E.COLI Issues • Elderly male with comorbidities and moderate LV dysfunction (LVEF 42%) • Fistuliuzing crohns disease with recurrent SAIO • Urinary tract infection (preclude BIOLOGICS) • SURGERY => high risk because of co-morbidities
73 Yrs Male with Hypertension, Chronic obstructive pulmonary disease (COPD), Dilated cardiomyopathy (DCM) content media
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Viswesh Velugula
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