Indira Tekwani
F/55
• HISTORY
• HCV / Cirrhotic Liver Disease - 2 ½ years 9-10
• Hepatic Encephalopathy ,Ascites +
• HRS+
• ? Diabetic Nephropathy one year
• Obesity
• Recurrent Hospitalisations
• Hypertension ,Diabetes - 8 yrs
• Hypothyroid - 22 years
• H/O off & on malena required blood transfusion last Jan 2009
• Did not tolerate antiviral in past [2006-07]
• Bl Group O+ve
• Operated for Umbilical hernia and hysterectomy 20 yrs back
• Obese / Grade I encephalopathy, mild pallor , mild pedal oedema
• INVESTIGATIONS
• HCV +ve [Genotype 3a] HCV RNA 1,14,350 viral copies/ml [08-09-2007] / was 19,37,000 0n [08-02-2007
• Hb 9.4
• TC 7100
• PC 118000
• S.Bilirubin : 0.59
• S Alk POase 186
• SGPT 14.38
• Albumin 2.7
• PT 1.19
• Na 134
• K 4.2
• Urea 40.02
• Creatinie 1.25
• USG Abdomen : Chronic Liver Parenchymal Disease
• Gall Bladder Calculi - Chronic Renal ParenchymalDisease
• ? Right colon colitis
• Mild ascites
• Left pleural effusion
• HBsAg : Negative
• Liver Biopsy : Chronic hepatitis [grade II] with moderate fatty change and cirrhosis [stage IV] 08/02/2007
16/06/2009
• Ammonia 20.0
• S Potassium 5.4
• S Sodium 139.0
• R Blood Sugar 122
• Alpha Fetoprotien 4.90
• S Creatinine 1.9 [11/06/2009]
• PT 15.2 – Control 11.5 INR 1.32 [11/06/2009]
• QUERY
• She had side effects with interferon and was withdrawn afte 9 doses in 2007?
• Ammonia increase 2-3 times in a month and is hospitalized with hepatic encephalopathy repeatedly ?
• Is there any medical treatment ?
• Should She Go For Liver Transplant ?
• Her daughter aged 35 years with two children and hemodynamically stable is the donor ?
• When should she go for the transplant ?
• What is the long term prognosis as she is HCV positive ? After Tranplant
• Would risk factors like Obesity ,Hypertension ,Hypothyroid ,Diabetes Mellitus and Impaired renal function affect the prognosis ?
• What will be the course of disease if no transplant is done ?
Thanks
Dr Kukreja