Problem solving 13/09/21 - 01

 



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2 min read - Cirrhosis

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A 55 years old male patient admitted to medical casualty with a febrile illness for 3 days with myalgia. Examination was unremarkable. He was previously well except for chronic bilateral knee joint osteoarthritis. He consumed liquor quarter to half a bottle on a daily basis. Investigations revealed. WBC - 5.6 Hb - 11.2 Plt - 135 AST - 45 ALT - 42 S.Cr - 54 He was managed as viral fever and became fever free the next day. However the platelet count was persistently low around 130. Further investigations arranged. Blood picture - Thrombocytopenia probably due to liver disease S. Bilirubin, ALP - Normal S. Albumin - 38, S globulin - 37 USS abdomen - Coarse echogenicity of liver. Mild portal hypertension. Mild splenomegaly. Compatible with chronic liver cell disease. This patient has Cirrhosis with portal hypertension. Now the obvious cause for his cirrhosis is alcohol, isn't it? NO! Just because of the history of significant alcohol consumption you ca...
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Describing an ECG

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Sir, this is a 12 lead ECG of Mr. blah blah. It is correctly calibrated. Heart rate is around 60/min, but there is a slight irregularity. P waves are normal and all p waves are followed by QRS complexes. Therefore, it is in sinus rhythm, and the irregularity is most likely to be due to sinus arrhythmia. The cardiac axis is normal. PR interval is normal. There are small Q waves in inferior and lateral leads. QRS complexes are normal and there is good R wave progression in anterior leads. There are prominent ST elevations in leads II, III and aVF. There are also mild ST elevations in V5 and V6. There is ST segment depression in aVL. T waves are upright and the QT interval appears to be normal. In conclusion, this patient has an ACUTE INFERIOR ST ELEVATION MI with possible lateral extension and reciprocal ECG changes in lead aVL. There is sinus arrhythmia, but no evidence of AV nodal dysfunction. I would like to do V4R and V7-V9 to look for right ventricular and posteri...
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