Case Presentation

1. Preliminary Data Date- 18-08-2017

• Name :-Mr.ABC
• Age :- 56
• Sex :- Male
• Occupation :-Business
• Marital Status :-Married
• Address :- Kondhwa ,Pune.
• Economical Status :-Middle Class
• Race :- Maratha.
• OPD No. :- SH – 328

2. Chief Complaint :- Pain in abdomen since 7 Days.

3. ODP:- ::- Patient was apparently alright A week back. On 11 th aug he
went to Dhule for his business work. Where he had lunch n dinner outside in
hotel . He came back to pune next day morning ( On 12 th Aug ) as the last
night he couldn't sleep well & he didn’t feel fresh in the morning. Along with it
he started complaining of low grade fever with Headache. As his business
work is important for him he couldn’t take rest & treated himself with
Tab.Acetaminophen 2 times a day for 2 days & continued the work but still
no relief. Next day Morning ( On 13 th Aug) He felt Nauseating n had two
episodes of vomitting also Because of it he got generalized weakness n also
had bitter taste in mouth. Inspite of not feeling well he continued his work
without rest. Four Days Passed in this on evening of (17 thAug ) he felt dull Pain
in the abdomen but after eating pain reduced During sleep again he started
Dull feeling pain in right hypochondriac region < Motion n Touch . He applied
pressure on painful region with pillow n sleep on right side whole night as it
Ameliorates his pain. On the next day Morning His Wife noticed that his eyes
are looking yellowish in color. N there fore he contact to his physician.
 There is No H/O Trauma, Recent Immunization,
Hematemesis , recurrent Diarrhea, Blood
Transfusion , Swelling of Joints Or Feets .

Location Sensation Modalities concomittant

Rt Dull pain < Motion , -
Hypochondriac Touch
Region

> Pressure.
4. Associated complaint:- Headache , Generalized
Weakness , Nausea, Bitter taste in Mouth.

5. Past history :- Nothing specific.

6.Family history :-Nothing specific.

7.Previous treatment :- Self Medicated

Tab.Acetaminophen for fever on (12th Aug) 2 tab 2
times a day for 2 days.
8.Personal History:-

• Appetite – Reduced Since Complaints.

• Craving – Hot 3 + ( No recent alterations)
• Aversion – Nonveg ( Never Taste Before Religious Family Background)
• Thirst – 8-10 Glasses per Day ( No recent alterations).
• Bowels – Since complaint started Constipated stools ,Yellowish in
coloured offensive Odour since complaint started has to go two times a
day previously he goes once a day.
• Urine – Since complaint started urine is Dark in color .
• Perspiration – on exertion.
• Sleep – On right side with covering Pressure >
• Dream – dreams of daily routine work . ( Sometimes Not Regular)
• Habits – Alcohol Started since college life Now Occasionally he Drinks.
• Thermal – Chilly ( Likes Summer, Takes Covering at Night, Hot Craving).
• Mind – Very attentive and concern about accuracy.
Finds faults in others .
9.General Examination :-
• Built :Average built.
• Pulse : 75 Beats/min .
• B.P : 110/70 mm of Hg.
• Temp : 99.7 F
• RR : 18/min.
• Wt : 60 Kg.

• Tongue : Yellow coated with Imprint of teeth.

• Yellowish discoloration of skin , sclera and mucous
membrane.
• No pallor, Clubbing, Edema, lymphadenopathy.
Palmer Erythema And Spider Nevi Absent.
• Xanthelasma Is Absent –( Symmetrical yellow
plaques around eyelids present in primary biliary
Cirrhosis.)
10. Systemic Examination:-

• CNS – Patient is Conscious & well oriented is answering

correctly to all questions as regards time and date etc.
• CVS- S1S2 heard.
• RS – AEBE Clear.
• Per Abdominal –
• Inspection : Umbilicus centrally situated. No scar of any
previous Surgery , no swelling.
• O/P -Examination of all 9 Abdominal Quadrant are done
. Fullness is present. Tenderness in Rt Hypocondriac
Region with mild Hepatomegaly n Palpable Spleen.
Murphy’s Sign Negative. Fluid three test is – ve. No
guarding Rigidity.
• Percussion : Fullness is Present Dull Note.
• Auscultation : Peristaltic Movements Auscultated.
• 12. Differential Diagnosis –
• Infective Hepatitis.
• Alcoholic Hepatitis.
• Chloecystitis.

• 13. Investigation :-
• Haemogram, Urine Routine , USG, LFT, HBsAg,
Anti-HAV IgM
14. Probable Diagnosis :- Infective hepatitis
(HAV).

16. Miasmatic Diagnosis:- psora miasm.

17.Analysis:-

MIND

I. Very attentive and concern about accuracy. (char).

II. Finds faults in others.(common).

PHYSICAL GENERAL :
III. Craving for Hot (char).
IV. Aversion Nonveg (com).
V. Bowel Constipated yellow coloured (char)
VI. Urine Dark Colour (Char)
VII. Perspiration On exertion (com)
VIII.Sleep on right side Pressure> (char)
IX. Thermal Chilly (char)
X. Tongue Yellow coted with Imprint of Teeth (Char)
XI. Dreams of daily routine (com).

PHYSICAL PARTICULAR :
XII. Pain in Rt Hypocondriac Region < Motion , Touch ,> Pressure (char)
18.Evaluation :-

I. Pain in Rt Hypocondriac Region < Motion , Touch

,>hard Pressure (char)
II. Tongue Yellow coted with Imprint of Teeth (Char)
III. Thermal Chilly (char)
IV. Sleep on right side Pressure> (char)
V. Bowel Constipated yellow coloured (char)
19. Probable remedies :-Chelidonium Majus
,Bryonia alba, Lycopodium.

20. Indicated remedy:- Chelidonium Majus

21. Prescription :-

Rx, Date – 18-08-2017

ABC
Chelidonium Majus 200 (globule no 30)
4pills * TDS *5 DAYS
Take 4 pills three times a day for 3 days.

Follow up – come after 3 days .

Sign :
Reg no :
Address:
22. Auxiliary line of treatment:-

• Avoid outside food .

• Have a nutritional diet that has high carb and low
proteins.
• Rest .
• Keep yourself well hydrated.

23. Prognosis -
Good. After taking medicine.
THERAPEUTICS
1) Chelidonium:
- The liver symptoms of chelidonium are very
Prominent.
- Soreness and stitching, shooting pain from
liver down into the stomach or down into the
back from posterior part of liver; marked pain
under the angle of right scapula even going
through the chest live a rivet.
-Abdomen distended and sensitive to pressure.
-Irregular palpitations of heart.
- Great weariness and anorexia
-It is remedy to be used in simple biliousness
and jaundice, and in hepatic congestion or
Inflammation.
-It causes the liver to secrete thinner and more
profuse bile than any other remedy.
-Jaundice due to hepatic and gallbladder
Obstruction.
-There is aggravation from motion and touch
and amelioration from pressure.
2) Merc sol:
-Right sided affection
-For congestion of liver, its complications and
end stage liver disease
-Yellow skin with itching < night ,warmth of
bed.
-Intense thirst even though tongue moist
excessive salivation.
-Bitter ,sweetish, foul taste in mouth
-Power of transforming healthy cells into
Necrotic.
-Malignancies.
- Profuse sweating day and night without
relief
which is offensive.
- Tongue large ,flabby with imprints of
teeth.
3) Magnesium mur:
-Pressing pain in liver area < walking, touch
and lying on affected side
-Ascites with hepatomegaly
-Liver hard and enlarged
-Sensation as if something is ragging in
abdomen
-Chronic induration of liver .
4) China:
-Liver hard ,small with pain < on touch
-Obstruction of gallbladder with colic
-Tympanatic abdomen and distention
must loosen cloths.
-Eructation and flatulence.
-Debility due to loss of vital fluids.
-Marked periodicity
-Constipation even soft stool voided with
difficulty.
5) Bryonia:
-The liver is swollen ,congested and
inflamed
Stitching pain the right hypochondriac
region <any motion>lying on right side
-Even on breathing pain in abdomen and
spits bile.
-One of the chief remedies for jaundice.
-Stools are hard and dry, or ,if loose,
papescent and profuse and associated
with colic.
6) Lycopodium:
-The region of the liver is sensitive to touch and
there is feeling od tension in it, a feeling as if a
cord were tied about the waist.
-Used for cirrhosis.
-The pains are dull and aching instead of sharp
and lancinating
-Fullness in the stomach after eating a small
quantity
-There are no real icteric symptoms but, there is
a peculiar sallow complexion.
7) Belladonna:
-Active violent congestion of all systems <
pressure, Breathing, coughing and lying upon
right side
-Severe pain in right hypochondriac in small
spots.
-Hepatic tenderness, pain radiates to right
shoulder and neck.
-Rapidly progressing disease.
-There is continuous retching and vomiting of
bile >on bending double
-Transverse colon protrudes.
- Uncontrollable vomiting .
8) Leptandra:
- Jaundice with black, tarry stools
- bilious constitution.
- feeble portal congestion.
-Dull, aching pain accompanied by
soreness.
-Burning distress in and about liver ,often
spreading to stomach and abdomen.
-Vomiting of bile.
-Frequent chilliness along the spine
THANK YOU.