Mehak Goyal Assignment: 1. What is your complete clinical diagnosis in the above case?

CCF, RHD, and Mitral Stenosis 2. What is the rationale for the investigations you want to order in this patient? Chest X-ray for determining size and shape of heart, pulmonary vessel hypertension Doppler echocardiography: for severity of valve disease Cardiac catheterization: any co-existing conditions 3. What are the complications you can expect in this patient if not treated adequately? Atrial dysrhythmias Systemic embolization (10-25%) Risk of embolization is related to, age, presence of atrial fibrillation, previous embolic events

Congestive heart failure Pulmonary infarcts (result of severe CHF) Hemoptysis Massive: secondary to ruptured bronchial veins (pulmonary HTN) Streaking/pink froth: pulmonary edema, or infection

Endocarditis Pulmonary infections

4. How do you manage the above condition? (3Marks) a. Drugs i. Diuretics for LHF/RHF ii. Digitalis/Beta blockers/CCB for Atrial fibrillation iii. Endocarditis prophylaxis b. Balloon valvuloplasty i. Effective long term improvement b. Surgical Mitral commissurotomy Mitral Valve Replacement Mechanical Bioprosthetic

CBL: 1) What is the complete clinical diagnosis in the above case? Patients serological test is positive for HBsAg. Past history suggests chronic active Hep b Infection. Confirmation for chronic hepatitis can be done due to prolonged prothrombin time, decreased albumin, increased globulins and elevated liver enzymes with increased total bilirubin. Patient complained of abdominal distension, yellow discoloration and breathlessness. Mild anemia and jaundice present with bilateral pitting pedal edema present. Swelling palpable in left hypochondrium. 8cm below left costal margin, moves with respiration shows hypersplenism. GI scopy: Grade IV oesophageal varices and fundal varices seen. Hence, diagnosed with Liver cirrhosis. Cirrhosis: Irreversible chronic injury of the hepatic parenchyma Extensive fibrosis - distortion of the hepatic architecture Formation of regenerative nodules Other Clinical Findings: Spider angiomas Palmar erythema Nail changes o Muehrcke's nails o Terrys nails Gynecomastia Testicular atrophy 2) What are complications you can expect in this patient? (3Marks) Ascites (combination of liver failure and portal hypertension) Portal Hypertension (complication of cirrhosis) Spontaneous Bacterial Peritonitis Hepatorenal syndrome Variceal hemorrhage Hepatopulmonary syndrome Other Pulmonary syndromes Hepatic hydrothorax Portopulmonary HTN Hepatic Encephalopathy Hepatocellular carcinoma

3) What are the medical and surgical modes of treatment available for this patient? Most common measured laboratory test classified as LFTs include o The enzyme tests (principally the serum aminotransferases, alkaline phosphatase, and gamma glutamyl transpeptidase), the serum bilirubin

o Tests of synthetic function (principally the serum albumin concentration and prothrombin time) Liver biopsy o Obtained by either a percutaneous, transjugular, laparoscopic, or radiographically-guided fine-needle approach

4) What are the methods of prevention of this particular clinical condition?(2marks) The major goals of treating the cirrhotic patient include: o Slowing or reversing the progression of liver disease o Preventing superimposed insults to the liver o Preventing and treating the complications o Determining the appropriateness and optimal timing for liver transplantation Hepatitis A and B Pneumococcal vaccine Influenza vaccination Develop healthy eating habits