Viral hepatitis

1. nagaking2011@yahoo.com

2. » Definition:
Hepatitis B is irritation & swelling(inflammation)of liver due to
infection with hepatitis B virus.(HBV)
» Symptom:
Yellowish skin& dark urine
fever,malaise,anorexia, nausea, vomiting,arthralgia ,fatigue,
Myalgia, splenomegally, hepatomegally,appetite loss
Less common cough,pharyngitis,arthritis,urticaria.
» Transmission:
Parentrally ( iv drug, blood transfussion, tattos),sexual contact,
organ transplantation share needle during drug
use, share personal item

3.  Test:
HBs Ag(surface antigen)is present from 1 to 6 month after
exposure.
HBeAg( e antigen)is present for 1 to 3 month after the
acute illness &implies high infectivity.
The persistence of HBsAg for more than 6 month define
carrier status & occur in 5-10 % of infection(chronic
infection)
 Treatment:
 Interferon, lamivudine, adefovir , entecavir, tenafovir ,
adefovir,(antiretroviral)

4. • IPnumber : 31757/12
• Admission Date: 11.12.12
• Discharge Date: 24.12.12
• Department/Unit: medicine / 2
• Age: 59
• Sex : F

5. Chief Complains & H/O Present illness:
• C/o yellowish discoloration of eye since 20 days
• c/o nausea since 20 days
• Patient was normal 20 days back ,when she noticed yellowish
discoloration of urine & eye.
• Previous history:
• No H/O fever/loose stool/abdominal pain /chest pain /palpitation
• No H/O TB/ asthma/HTN /epilepsy /DM

6. Social History:
+ Diet: mixed
+ Sleep: disturbed
+ Appetite: decreased
+ Bowel And Bladder: regular
+ Habit: none

7. • Blood Pressure: 110/70 mm /Hg
• Pulse Rate: 78 beat/min
• Temperature: Afebril
P I + C C L E

8. ˃ Respiratory system: : NVBS+, no added sound, chest wall symmetric
˃ CVS : S1S2 + , no murmur
˃ P/A : soft , non tender ,no organomegaly
˃ CNS: HMF (N) , motor & sensory system (N)

9. Laboratory data:
Test Normal value Test value
HB g/dl 12-16 13.2
TC cell/cmm 4.5-11k 8.2 k
P 40-75 60
L 25-33 28
E 1-3 04
M 3 -7 06
platelet 1.3-4 1.99lakh
S.ELECTROLYTE
NA mmoll 135-145 139
K mmol/l 3.5-5 3.5
CL mmol/lit 96-106 101
BUN mg/dl 11 - 23 13
SR.CREATININ
mg/dl
0.9-1.5 0.9

10. TEST NORMAL
VALUE
Test value
urine examination
Albumin Nil
PC Nil 2-3
EP trace 0-1
ESR mm/hr 0-20 15
TB (mg/dl) 0.3 -1 23.6
DB (mg/dl) 0.1-0.3 20.8
SGOT (AST) 8- 40 iu/l 972
SGPT (ALT) 8 -40iu/l 489
Alb (g/dl) 3.5 -5.5 5.5
HBsAg Positive
HCV Non reactive
HBeAg Non reactive

11. ˃ Based on the subjective and objective evidences the patient was diagnosed
to have hepatitis B.

12. Brand Name Generic Name
Dose &
Frequency
Date
Begun
Date Ended
T Livopill-Ds Silymarin 70mg ,
metadoxine 250mg
ornitine aspartate
Thiamine 10mg
1-0-0 11.12.12 24.12.12
Iv Fluid DNS Dextrose normal saline 12.121.2 15.12.12
Iv Emeset amp Ondansetron 4mg sos 11.12.12 19.12.1.2
Iv veloz Pantoprazole 40mg 1-0-0 11.12.12 15.12.12
T Pan Pantoprazole 40mg 1-0-0 15.12.12 19.12.12
Inj Vit K Vit k 1-0-0 11.12.12 22.12.12
Inj vegacef Ceftriaxone 1gm 1-0-1 11.12.12 18.12.12
Syp Bevon Vitamine & mineral 10ml 1-0-1 11.12.12 24.12.12
Syp Duphalac Lactoluse 15ml 14.12.12 22.12.12
T Zifi CV Cefexime 200mg 1-0-1 18.12.12 23.12.12
T Zofer MD onadansetron 4mg sos 18.12.12 23.12.12
T Zolfresh zolpidem 20mg 0-0-1 20.12.12 22.12.12

13. Brand name Generic name Dose & frequency Date begun Date ended
T udilive Ursodeoxycholic acid 300mg 1-0-0 20.12.12 24.12.12
T lamivir lamivudin 150mg 1-0-1 22.12.12 24.12,12

14. Test Test value
17.12.12
Test value
20.12.12
Normal value
TB mg/dl 20.6 20.4 0.3-1 mg/dl
DBmg/dl 18.4 18.1 0.1 -0.3 mg/dl
SGOT (AST) 534 372 8 – 40 iu/l
SGPT (ALT) 221 156 8-40 iu /l
TP 8.2 8.2 6.6-8.3
ALb g/dl 5 5 3.5-5

15. Brand Generic name Dose frequency
T livopill-DS Silymarin 70mg ,
metadoxine 250mg
L ornitine aspartate
Thiamine 10mg
folic acid 1mg
1-0-0 1 month
T zofer MD onadansetron 1-1-1 3 days
Syp duphalac Lactoluse 0-0-1 15ml 2 wks
T lamivir lamivudin 1-0-1 150mg TC
T pantodac pantoprazole 1-0-1 40mg 2 wks
T udiliv Ursodeoxycholic
acid
1-0-1 300mg TC

16. Suggestion to the physician :
 The 2 first line medicine lamivudin & interferon should
be given in case of hepatits B.

17.  Avoid alcohol.
 Drink plenty of fluid.
 Do not eat oily food.
 Avoid carbohydrate a& protein rich food.( red meat
,potato, nut)
 Take sugar can juice
 Reduce salt intake ,to prevent bloating that may cause
swelling of liver
 Don’t donate blood ,body organ
 Don’t share tooth brush,wash cloth,syringe