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Portal HTN By Amit.pptx

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This document presents the case of a 10-year-old boy named Hasib who presented with gradual abdominal distension and occasional pain for 3 months, as well as blood mixed vomiting for the past week. On examination, he was found to have mild anemia, abdominal distension, and an enlarged spleen. His provisional diagnosis was rupture of esophageal varices due to portal hypertension. Further investigations including endoscopy, imaging, and liver function tests were planned to confirm the diagnosis.

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Dr.Amit Hasan Phase-A Paediatric surgery, MMC.
Long case presentation : Portal hypertension
Particulars of the patients Name:Hasib Age:10 years Sex:Male Religion:Islam Address:Muktagachha Date of admission :15/10/22 Date of examination :15/10/22
Chief complaints : 1)Gradual abdominal distension with occasional pain for 3 months. 2)Passage of blood mixed vomiting for 3 times within last 7 days.
History of present illness : According to the statement of the patients mother he was reasonably well about 3 months back. Then he developed gradual abdominal distension which was associated with occasional left sided upper abdominal pain. The pain is mild in nature, non radiating, aggravated by playing and eating and relieved by taking analgesic. He also developed vomiting for 3 times in last 7 days.
Vomitus was profuse in amount, foul smelling,reddish in colour, contain digested food materials. He has no history of blood transfusion, per rectal bleeding, abdominal trauma. His bowel and bladder habit is normal.
History of past illness : There is a history of mild jaundice 1 year back which subside by taking medication from local physician.
Birth history : Hasib was born by normal vaginal delivery at term with an average weight. After delivery her umbilical cord was cut with brand new blade and tied with healthy measures.
Feeding history : Exclusive breast feeding upto the age of 6 months. Then complementary feeding continued with appropriate weaning food . Now he is on family diet.
Immunization history : Completed as per EPI schedule.
Developmental history : His development is age appropriate.
Family history : 2nd issue of non consanguineous parents. There is no positive family history of any bleeding disorder or such types of health problem.
Blood transfusion history : No history of blood transfusion.
General examination : Appearance : ill looking, conscious, co-operative. Anaemia : mild Jaundice : absent Edema: absent Cyanosis: absent Dehydration: absent Clubbing : absent
Leukonychia: absent Palmer erythema: absent Flapping tremor : absent Spider naevi: absent Pulse rate 65 beats/min Respiratory rate- 20 breaths/min Blood pressure -90/60 mm of hg
Temperature -98属F BCG mark present Ear,Nose,Throat normal Lymph nodes not palpable Spine- normal Hernial orifice intact
Systemic examination : Gastro intestinal system : Inspection : Mouth and oral cavity : No bleeding manifestation. Gum and oral mucosa healthy.
Abdomen was mild distended, flanks were full, umbilicus was centrally placed,everted. There was no engorsed vein and visible peristalsis. Palpation: Abdominal temperature is normal. It was non tender and soft in consistency. Spleen was enlarged, about 4 cm along its long axis towards RIF,borders were sharp,surface smooth, firm in consistency, splenic notch was present in the upper border of spleen.
Liver was palpable just below the right costal margin and upper border of the liver dullness found in 4th intercostal space in midclavicular line. Fluid thrill was absent. Percussion : Shifting dullness was present. Auscultation : Bowel sound was present.
Nervous system : Patient was conscious, oriented about time, place,person. Cranial nerve was intact. Motor functions were normal. There was no flapping tremor. Gait was normal. Sensory functions were normal.
Cardiovascular system : 1st and 2nd heart sound were audible in all cardiac areas. There was no added sound.
Respiratory system Breath sound was vesicular, there was no added sound. Other system examination revealed no abnormality.
Salient feature Master Hasib,10 years old, 2nd issue of non consanguineous parents, hailing from Muktagachha, presented to me with the complaints of gradual abdominal distension associated with occasional abdominal pain for last 3 months. The pain is situated in the left hypochondriac region which is mild in nature, aggravated by playing and eating, subside by taking medication.
There is also haematemesis for 3 times within last 7 days. Vomitus was profuse in amount,foul smelling,reddish in colour,contain digested food particles. He has no history of blood transfusion, per rectal bleeding, abdominal trauma. His bowel and bladder habit is normal. Hasib was ill-looking, co-operative, mild anaemic, non icteric,non edematous.
His pulse rate was 70 beats/min. Respiratory rate- 20 breath/min. Blood pressure -90/60 mm of hg.There was no stigmata of chronic liver disease. Abdomen was mild distended, flanks were full, umbilicus was centrally placed and everted. There was no visible engorsed vein and peristalsis. Abdominal temperature was normal. It was non tender and soft in consistency.
Spleen was enlarged 4 cm from left costal margin towards RIF, non tender, firm in consistency, surface smooth, sharp border,splenic notch present in the upper border. Liver was palpable just below the right costal margin and upper border of liver dullness was present in 4th intercostal space. Fluid thrill was absent. Shifting dullness and bowel sound was present. Other systemic examination revealed no abnormality.
Provisional diagnosis : Rupture esophageal varices may be due to Portal hypertension
Differential diagnosis : 1)Chronic liver disease 2)Choledocal cyst
Investigation : Upper GIT endoscopy Imaging Ultrasonography with doppler interrogation of hepatic vessel. Fibroscan of liver Computed tomography Magnetic resonance angiography
Transjugular portal venogram. Liver biopsy CBC LFT Coagulation profile HBsAG S.Electrolyte
Thank you very much.
Portal HTN By Amit.pptx
Portal HTN By Amit.pptx
Confirmatory diagnosis : Rupture esophageal varices may be due to portal hypertension.
Portal HTN By Amit.pptx

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Portal HTN By Amit.pptx

  • 2. Long case presentation : Portal hypertension
  • 3. Particulars of the patients Name:Hasib Age:10 years Sex:Male Religion:Islam Address:Muktagachha Date of admission :15/10/22 Date of examination :15/10/22
  • 4. Chief complaints : 1)Gradual abdominal distension with occasional pain for 3 months. 2)Passage of blood mixed vomiting for 3 times within last 7 days.
  • 5. History of present illness : According to the statement of the patients mother he was reasonably well about 3 months back. Then he developed gradual abdominal distension which was associated with occasional left sided upper abdominal pain. The pain is mild in nature, non radiating, aggravated by playing and eating and relieved by taking analgesic. He also developed vomiting for 3 times in last 7 days.
  • 6. Vomitus was profuse in amount, foul smelling,reddish in colour, contain digested food materials. He has no history of blood transfusion, per rectal bleeding, abdominal trauma. His bowel and bladder habit is normal.
  • 7. History of past illness : There is a history of mild jaundice 1 year back which subside by taking medication from local physician.
  • 8. Birth history : Hasib was born by normal vaginal delivery at term with an average weight. After delivery her umbilical cord was cut with brand new blade and tied with healthy measures.
  • 9. Feeding history : Exclusive breast feeding upto the age of 6 months. Then complementary feeding continued with appropriate weaning food . Now he is on family diet.
  • 10. Immunization history : Completed as per EPI schedule.
  • 11. Developmental history : His development is age appropriate.
  • 12. Family history : 2nd issue of non consanguineous parents. There is no positive family history of any bleeding disorder or such types of health problem.
  • 13. Blood transfusion history : No history of blood transfusion.
  • 14. General examination : Appearance : ill looking, conscious, co-operative. Anaemia : mild Jaundice : absent Edema: absent Cyanosis: absent Dehydration: absent Clubbing : absent
  • 15. Leukonychia: absent Palmer erythema: absent Flapping tremor : absent Spider naevi: absent Pulse rate 65 beats/min Respiratory rate- 20 breaths/min Blood pressure -90/60 mm of hg
  • 16. Temperature -98属F BCG mark present Ear,Nose,Throat normal Lymph nodes not palpable Spine- normal Hernial orifice intact
  • 17. Systemic examination : Gastro intestinal system : Inspection : Mouth and oral cavity : No bleeding manifestation. Gum and oral mucosa healthy.
  • 18. Abdomen was mild distended, flanks were full, umbilicus was centrally placed,everted. There was no engorsed vein and visible peristalsis. Palpation: Abdominal temperature is normal. It was non tender and soft in consistency. Spleen was enlarged, about 4 cm along its long axis towards RIF,borders were sharp,surface smooth, firm in consistency, splenic notch was present in the upper border of spleen.
  • 19. Liver was palpable just below the right costal margin and upper border of the liver dullness found in 4th intercostal space in midclavicular line. Fluid thrill was absent. Percussion : Shifting dullness was present. Auscultation : Bowel sound was present.
  • 20. Nervous system : Patient was conscious, oriented about time, place,person. Cranial nerve was intact. Motor functions were normal. There was no flapping tremor. Gait was normal. Sensory functions were normal.
  • 21. Cardiovascular system : 1st and 2nd heart sound were audible in all cardiac areas. There was no added sound.
  • 22. Respiratory system Breath sound was vesicular, there was no added sound. Other system examination revealed no abnormality.
  • 23. Salient feature Master Hasib,10 years old, 2nd issue of non consanguineous parents, hailing from Muktagachha, presented to me with the complaints of gradual abdominal distension associated with occasional abdominal pain for last 3 months. The pain is situated in the left hypochondriac region which is mild in nature, aggravated by playing and eating, subside by taking medication.
  • 24. There is also haematemesis for 3 times within last 7 days. Vomitus was profuse in amount,foul smelling,reddish in colour,contain digested food particles. He has no history of blood transfusion, per rectal bleeding, abdominal trauma. His bowel and bladder habit is normal. Hasib was ill-looking, co-operative, mild anaemic, non icteric,non edematous.
  • 25. His pulse rate was 70 beats/min. Respiratory rate- 20 breath/min. Blood pressure -90/60 mm of hg.There was no stigmata of chronic liver disease. Abdomen was mild distended, flanks were full, umbilicus was centrally placed and everted. There was no visible engorsed vein and peristalsis. Abdominal temperature was normal. It was non tender and soft in consistency.
  • 26. Spleen was enlarged 4 cm from left costal margin towards RIF, non tender, firm in consistency, surface smooth, sharp border,splenic notch present in the upper border. Liver was palpable just below the right costal margin and upper border of liver dullness was present in 4th intercostal space. Fluid thrill was absent. Shifting dullness and bowel sound was present. Other systemic examination revealed no abnormality.
  • 27. Provisional diagnosis : Rupture esophageal varices may be due to Portal hypertension
  • 28. Differential diagnosis : 1)Chronic liver disease 2)Choledocal cyst
  • 29. Investigation : Upper GIT endoscopy Imaging Ultrasonography with doppler interrogation of hepatic vessel. Fibroscan of liver Computed tomography Magnetic resonance angiography
  • 30. Transjugular portal venogram. Liver biopsy CBC LFT Coagulation profile HBsAG S.Electrolyte
  • 31. Thank you very much.
  • 34. Confirmatory diagnosis : Rupture esophageal varices may be due to portal hypertension.