dr.bhavin ald case

7/27/2019 Dr.bhavin ALD CASE

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welcome


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ByDr. Bhavin Kathiriya2nd yr p GDept. of Kayachikitsa.


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Name : Sumit trivedi

Age : 35 yrs

Sex : male

Address: Kolkatta, W.Bengal

Marital status: Married Occupation: Software Engineer

I.P.No: 76912

Date of admission : 02/07/12

Date of discharge : 26/07/12


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Pt c/oLow back pain since 10 years, stiffness in the back

Inequality in the length of both legs( left leg incresed by 2inch.) since 2 years. Sometime c/o. pain in both shoulder

joints and right hip joint.

.


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Piles since 2 years


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Patient named of Sumit ,aged 35 was apparentlyhealthy 9 years back. Gradually in the september 2003he started having pain in low back and left sacroiliacjoint. For this he started taking pain killer.

Later in 2004 even after taking pain killer, he couldntfind relief. So he approached a doctor where he wasdiagnosed he is suffering from ankylosing spondylitisHLA_ b27. He was advised NSAID and certainexercise. He started taking tablets but didnt do theexercises. And the interval of pain started reducing to2 month.


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In 2008 september, he stopped all conservative medicineand started doing accupressure for 6 months but during

this his pain aggravated. Now he started having pain inthe cervical region radiating down also in the spine. He,now also have stiffness in the spine also.

In 2009 January, he stopped accupressure treatment and

came to sdm udupi for ayurvedic


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treatment under Dr. Muralidhar Sharma Sir. He wasgiven basti, agnichikitisa lepa, kaishor guggulu. But he

couldnt appreciate much change so he stopped thetreatment and again started with pain killer.

During this time he also developed the deformity in lefthip joint due to which his range of movements were

markedly diminished and their was inequality in lengthof two legs. The left leg became longer than right.

But finding it harmful for the body he thought to takeayurvedic treatment once again so he came to our

hospital on 2nd july 2012.


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Nature of pain: diffused, pricking

increases in the morning

Interval : 3 months Duration: 1 week

Aggravating factor: not specific

But he has observed that pain that episode of pain

increases in winter

Relieving factor: analgesics


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No history of fever, gastric disturbance,


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No significant past history is recorded. Patient is nondiabetic and non hypertensive


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Not a known case of diabetes mellitus andhypertension


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All family members are said to be healthy (wife and 2 daughter).

Father and mother stay together.


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Appetite : Good

Diet: mixed

Sleep : Normal (7 hrs night )

Bowels : (once/ day, constipated)

Micturition : 5-6 times /days Habits : alcohol : Ocasionally

Smoking : 5-6 cigarats/day priviously (stopped since 2011 )

Tea: 2 times/ day


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Appearance - Normal

Built - NormosthenicNutrition - Moderatly nourished

Cyanosis - abPallor - present

Icterus - presentOedema - pedal edema; non pitting typeHeight - 169cms

Weight - 75 kgTongue - coatedLymphadenopathy- abGait - limphingSpeech - intact


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Temp - 98.6*F

Pulse - rate 78/minResp rate - 22/minB.P - 130/90 mm of Hg

J.V.P. - not raised.


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CVS EXAMINATION-

S1 & S2 heard , no added sounds..

RESPIRATORY SYSTEM EXAMINATION-

Normal vesicular breath sounds, no creps , No added sound.


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HIGHER MENTAL FUNCTIONS: Intact.

Cranial Nerves- Intact

Motor and Sensory system- Intact


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INSPECTION

Distension of abdomen present

Scars : absentStriae :absentDialated vein : absentRashes : absent

Umbilicus : invertedContour of the abdomen: symmetrical


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COMPLETE BLOOD COUNT

Hb 10.5 gms%

WBC 16500 cells/cumm17300 ( 2/7/12)

ESR 54 mm/hr84 ( 2/7/12)

DIFF. COUNT OF WBC

N 80%

L 16%

Eosinophils 4%

Monocytes 0%

Basophil 0 %

Total RBC 2.9 millions /cumm

Platelet count 2.6lakhs / cumm

PCV (Hct) 32 %

MCV 108 fl

MCH 35.5 pg

MCHC 32.8 gms %


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Random Glucose : 71 mg/dl ( 60 -140 ) Blood Urea : 12 mg/dl (10-50)

Serum creatinine : 0.6 mg/dl (0.6-1.4)


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Total bilirubin 16.2 mg/dl

Direct Bilirubin 9 mg/dl (0-0.3)

Indirect Bilirubin 7.2 mg/dl (0-0.9)

SGOT 154 U/L ; 152 (2/7/12)SGPT 61 U/L; 74

Alkaline Phosphate 139 U/L

Total Protein 7.2 g/dl

Albumin 3.2 g/dl

Globulin 4 g/dl

A/G Ratio 0.8


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Negative ( 25/06/12 )

Negative

Negative


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Alcoholic liver disease? Cirrhosis

? Regeneration modules/ HCC in the left lobe

Mild Splenomegaly

? Portal hypertension G.B. sludge


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27/06/2012

Features suggest the possibility of cirrhosis of liver withmoderate Ascites and Minimal left Pleural effusion.

cirrhosis of liver


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JAUNDICE WITHdistension of abdomen

& pedal oedem

PRE HEPATIC

ANEMIA , FEBRILEILLNESS ,

NO BLEEDING

HEPATIC

HEREDITARY

GILBERTSSSUNDROME

INFECTIVE

HEPATITIS

CHRONIC

ALCOHOLINDUCED

DRUG INDUCED

POST HEPATIC

CLAY COLOUREDSTOOLS,

COLICY ABDOMENPAIN

MURPHYS SIGN


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Clinical diagnosis - Jaundice

Anatomical diagnosis - Hepatitis

Etiological diagnosis - Alcohol induced Hepatitis

Pathalogical diagnosis-Alcohol induced Hepatitis

( cirrhosis of liver with moderate Ascites )


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I/O chart

Inj. Lasix 40 mg iv stat

Tab. Lacilectone 1-1-0

Shrikhandasava 3 tsp tid

Tab nirocil 1-1-1Shivagutika 1-0-1

Inj. Cefaday 1 gm iv BD ( till 14 dose)

Inj genta 80 mg iv BD ( 5 dose)Feeding resticted to 1500 ml / day


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Alcoholic Liver disease: Alcohol is metabolized exclusivelyby the liver.

pathway1)Alcohol Acetaldehyde

ADH

This Acetaldehyde adducts with cellular protein in

hepatocytes which activates immune system leading to cellinjury.

Alcohol when metabolized with oxidase enzyme whichconverts etanol to acetate leading to release of free radicals,leading to lipid preoxidation which induce mitochondrial

damage and there by hepatic damage .


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Nadi 78/min

Mutra vikruta (2-3 times/day)

Mala vikruta

Jivha Alipta Shabda prakruta

Sparsha Prakruta

Drik pita varna in shukla mandala

Akriti Madhyama.


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Dasa vidha pareeksha

Prakriti: pitaja-vataja (chapala gati, chestabahupralapa,

ushna asahishnuta, sheta preeyata,

guru gatra, kshuda, sweda adhikata)

Vikriti: Hetu: Ahara :- katu, ati ushna, vishama ashana,Akala ashna

Vihara:- ati shrama, ati madya sevana,

Ratri jagarna

Manasika:- Ati vishada, Ati chinta Dosha:- Tridoshaja ( pita ulvanata)

Dhatu:- Rasa, Rakta, Mamsa, Medas

Desha:- Aanupa


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Kala:- Aadana kala

Bala:- Madhyma

Vyadhi bala:- Madhyma

Saara:- Avara(Madya has all opposite gunato ojas , so on long standing drinking of

madya leads to ojo kshaya and thus saptadhatu saara will be kshaya)


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Samhana:- Madhyma

Pramana:- madhyma

Saatmya: madhyama

Satva: avara

Ahara shakti:- Madhyma

Vyama Shakti:- Madhyma

Vaya: Madhyama


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Nidana:Ahara :- katu, ati ushna, vishama ashana,

Akala ashna

Vihara:- ati shrama, ati madya sevana,

Ratri jagarna

Manasika:- Ati vishada, Ati chinta Poorvaroopa: Aruchi, Annanabhilasha, chhardi in

morning before brushing

Roopa. Pita varna in netra and mutra, ishat pitata

in hasta, udara, shotha in pada. Manda jvara, alpa muutrata, atisara

Upashaya anupashaya: nothing specific


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Ati madya. Ati katu ahara, vishmaashana, ati shrama, ratri jagrana

chinta

pitta pradhan dushti with tridoshadushti

Agni dushti

Agni mandhya producingaam

Circulation of saama dosha withrakta)

Raktavaha sroto dushti

Adhika rakta mala utapatti

Circulation of raktamala(pitta) with rakta

Sthana samshraya in moola of rakta

and mamsa causing rakta mamsadushti

KAAMALA(Koshtha ashritakamala)

KUMBHKAMALA

Kalantar


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Dosha: Tridosha (pitta pradhan- pachaka,

bhrajaka, alochaka,vata- vyana, samanakapha- kledak)

Dushya: rasa rakta mamsa medas Updhatu twak Mala mutra, purisha Agni: jatharagni , dhatvagni Agnidushti manda Srotas: rasavaha, raktavaha, annavaha

Srotodusthi: sanga, vimarga gamna Udbhava sthana: amashaya Sancharasthana koshta Vyakta sthana: tvak, netra, mutra, koshta Rogamarga: Bahya and Abhyantra.


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Shakha ashrita kamala Halimaka

Pittaja madatya janaya kumbha kamala


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Disease Inclusion Exclusion

Shakha ashrita kamala Haridra mootra, netra,twak, avipaka,agnimandhya

Kapha vata prakopna ispathology.Vishtabdhata, swetavarchas

Halimaka Pita varna, bala kshaya,mrudu jvara

Daha, trishna, utsahakshaya

pittaja madatya janaya

kumbha kamala

Jvara, atisara, haridravarna of tvak

Pita varna of netra, tvak,nakha, mutra, purishashotha


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Pittaja madatya janya kumbha kamala


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Patient is a shop owner. He works for 16 hours i.e. ativyama and sleeps for 5hrs in night on long run leads tovata vridhi.

He has habit of consuming ati tikshna, katu aaharawhich vitiate pitta in patient.

Patient has habit of consuming madya since 15 years.

According to acharya charaka in chikitsa sthana 24th

chapter explains that all madyataya are tridoshajanaya. Their could be either

One dosha ulvanta

Two dosha ulvanta Vrudha, vrudhatara and vrudhatama

Sama sannipata


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Madya has all opposite gunas to ojas and same guna tovata thus it does the kshaya of ojas and vridhi of vata.

. ./

Person has which increase rajas and which

in turn increase pitta in body. - . .

Thus we see the vitiation of all the three doshas .

is (.. )


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is a . . . .. Koshtashrita kamala is bahu pittaja vyadhi.


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the patient should be given abhyantara snehapana with

panchgavya ghruta, mahatiktaka ghruta and after that mruduvirechana should be done.

Virechana can be given with trivrut kalka with triphala kwatha

or danti 24 gms with 48 gms of guda

After this patient should follow diet.


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dr.bhavin ald case

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