65 year old with HCV

65 year old male, a chronic alcoholic, came to casuality with c/o fever since 23 days associated with generalised weakness, irrelevant talk and drowsiness since 1 day. 

He has h/o binge drinking since 4-5 days without eating followed by irrelevant talk and drowsiness since 1 day. 

No h/o headache, vomiting, loss of consciousness/seizures

No h/o cough. 

No other complaints.  


Past history:

Right femur fracture due to fall from bike 6 months back “rod inserted” and similar complaints at that time due to excess drinking. 

N/k/c/o dm, htn, tb, asthma, epilepsy, cad, cva. 


Personal history:

  • Mixed diet
  • Normal appetite 
  • Bowel regular
  • Micturition normal
  • Chronic alcoholic since 40 years
  • Chronic smoker since 40 years- smokes 4-5 chutta/day 


Family history: not significant. 


General examination:

  • Patient is conscious, non coherent, non cooperative. 
  • Moderately built and nourished.
  • Icterus present
  • No pallor, cyanosis, clubbing, lymphadenopathy, edema, dehydration 


Vitals: 

  • PR: 140 bpm
  • BP: 110/60 mm Hg
  • TEMP: 101 F
  • SpO2: 94%
  • GRBS: 166mg%


Systemic examination:

  • CVS: s1 s2 heard. No murmurs
  • RS: BAE + NVBS+ no added sounds
  • P/A: soft, tenderness present in right hypochondrium and epigastric region. Bowel sounds +
  • CNS: 


Provisional diagnosis:

Altered sensorium under evaluation secondary to alcohol intoxication/uti/pneumonia. 

HCV


INVESTIGATIONS: 

CBP:

  • Hb: 15.5
  • TLC: 5,500
  • RBC: 6.22
  • Platelets: 1.10
  • Lymphocytes: 45
  • Neutrophils: 48


ESR: 35mm/1st hr


LFT:

  • TB: 7.02
  • DB: 2.40
  • AST: 234
  • ALT: 77
  • ALP: 876
  • Total proteins: 6.1
  • S. Albumin: 2.0
  • A/G: 0.52


S electrolytes: 

  • Na: 129
  • K: 5.2
  • Cl: 100


S creatinine: 0.9 mg/dl


S urea: 85 mg/dl 


RBS: 60mg/dl


PT: 17 sec


INR: 1.2


APTT: 34 sec


S lipase: 18.2


S amylase: 33.0


HBsAg: negative


HIV: negative


HCV: reactive


Rapid dengue: negative. 


USG ABDOMEN: 

  • Altered echo texture of the pancreas with dilated MPD-? Acute on chronic pancreatitis 
  • Hepatosplenomegaly
  • Altered echo texture of liver with edematous hall bladder wall- s/o serositis


2D ECHO:

  • Good LV systolic function. EF: 58%
  • No RWMA. NO MS/AS
  • Trivial TR+/AR +
  • Sclerotic AV, no PAH/PE
  • No LV clot
  • Diastolic dysfunction +
  • IVC size: 1.4 cms


ECG:



CHEST X RAY:



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