Alcoholic Liver Disease: ICD Code:-K70.10

Alcoholic liver
disease
ICD code:-
K70.10 Presented by:-
Arun arora
Chahat
Rita
Diksha
Ramandeep
Subjective
Age:-
Subject name:- Mr. Jitender Sex:- Male
42years
Date of admission:-25/7/17 Ward:- General
Date of discharge:- 2/9/17 Medicine
ALS:- 8 Days IP No:-1707258
Chief complaints:-
• Pain in Abdominal From 15 days
• Distention of abdomen from 10 days
• Yellowish discoloration of urine & dark brown
• Coloured stool 2-3 episodes/day
Objective
On Examination
P⁻ I⁻ C⁻ C⁻ L⁻ E⁻
Measure Unit Day1 Day2 Day3 Day4 Day5 Day6 Day7 Day8
BP mmHg 160/1 130/9 160/9 140/9 160/9 150/7 160/9 130/7

00 0 0 0 0 0 0 0
PR Beats/min 96 96 88 86 82 80 84 72
RR /min 16 20 18 20 18 20 20 20
Temp. ⁰F A A A A A A A A
Past History
Past medication history:-
Past medical history:- On/Off medication for
• Jaundice 1 month treatment of UC
• HTN 1 year (Mesalamine,
Prednisolone)
Social history:- chronic smoker and alcoholic from 15
year
Family history:- not significant
Allergies (drug):- not Allergies (food):- not
significant significant
Assessment
Laboratory investigation
report:-
Test Name Range Day 1 Day3
ESR 0-9 mm 1st hour 20
TLC 4-10 x 1000/cumm 2000 9700
TG 35-160 162
HDL 35-79 26
Total bilirubin 0-1.20 mg/dl 5.6 4.8
Direct bilirubin 0-0.20 mg/dl 4.3 3.9
SGOT 2-31 IU/L 56 42

Total protein 6.6-8.7 g/dl 5.7 6.2
Albumin 3.5-5.2 g/dl 2.2 2.5

Prothrombin time 11-16 9.5 9.7
INR 1.24
Abdomen
GALL BLADDER DISTENDED
IMPRESSION:- LIVER PARENCHYMAL DISEASE WITH
ASCITES FATTY LIVER WITH HEPATOMEGALY
Diagnosis
Provisional Diagnosis: ALD with massive ascites
Final Diagnosis:-alcoholic liver disease

Therapeutic Goal and
PLAN
Plan
Goal:- Goals of Therapy
SHORT TERM GOALS
Non Pharmacological therapy
•Relieve the swelling.
Tab. Pantop
Tab. Thiamine •Treat breathlessness.
Tab. BC forte •Bring the patient in a stable
Tab. Amlog condition.
Tab. Dytor LONG TERM GOALS
Tab. Emset •Decrease the risk of future
Protein powder
heart attacks.
Inj. Ceftriaxone
•Decrease the risk of further
complications
Medication chart
DRUG NAME Generic Name DOSE ROUTE FREQUENCY
Inj. Vit k Vitamin K 2 mg IM OD
Tab. Rifagut Rifaximin 40mg PO TDS
Tab. Ciplar Propranolol 40 mg PO OD
Tab. Dytor Torsemide 40 mg PO OD
Inj. Ceftriaxone Ceftriaxone 1 gm IV BD
Syp. Lactulose Lactulose 2 tsp PO HS
Cap. Cyra -D Rabeprazole + 40 mg PO OD

Domeperidone
Powder Protimax Protein 1 tsp PO TDS
Tab. Thiamine Thiamine 100 mg PO OD
Inj. Pantop Pantoprazole 40 mg IV OD
Inj. Emset Ondansetron 4 mg IV TDS
Inj. Amlog Amlodipine 5 mg OD OD

-
DRUG NAME DAY 1 DAY DAY 3 DAY 4 DAY 5 DAY 6 DAY 7 DAY 8
2
Inj. Vit K Omit
Tab. Rifagut
Tab. Ciplar
Tab. Dytor
Inj.
Ceftriaxone
Syp. Lactulose
Cap. Cyra- D Omit
Powder
Protimax
Tab. Thiamine Omit
Inj. Pantop
Inj. Emset
Tab. Amlog
Root Cause Analysis
PLAN MEDICATION STG RCA
Rx
Non Pharmacological Alcohol Abstinance Main cause
Treatment
Nutritional support Nutritional Support To reverse fatty liver
Tab. BC forte Anti oxidants Alcohol mediates oxidative stress
like lipid peroxidation
Corticosteroids To reduce pro-inflammatory
response
Tab. Dytor Tab. Dytor For HTN & Ascitis
Tab. Thiamine Tab. Thiamine To reduce neurological disorder
Inj. Ceftriaxone Inj. Ceftriaxone Prophylaxis
Tab. Amlog Tab. Amlog For hypertension
Tab. Pantop Tab. Cyra D For slight Nausea
Protein Powder Protimax Due to less protein
Powder
Tab. Emset Inj. Emset Due to feeling of slight nausea
Tab. Ciplar For HTN
Syp. Lactulose For encephalopathy
Tab. Rifagut Prophylaxis, reduce ammonia
production
Overview of ALD Drugs
STG THERAPY
1.Glucocorticoids : 1ST LINE When the symptoms are
Pentoxifylline (400mg,BD) THERAPY not relieved by first line
2. Specific anti- TNF-α therapy we switch to
therapy second line therapy.
3.Anti-oxidants. Despite of maximum
Vitamin C (100-250mg, QD) dose.
Vitamin E (30-1000IU, BD)
N-Acetylcysteine
(500mg,OD)
1.Silymarin (160-800mg,TDS) 2ND LINE When the symptoms are

2.S-adenosylmethionine (800- THERAPY not relieved by first line
1600mg,OD) therapy we switch to
3.Betaine (500mg,OD) second line therapy.
Despite of maximum
dose
Liver transplantation 3RD LINE End stage

THERAPY
Patient
Counselling
About food
 Patient should take garlic, grapefruit, green tea, apples, olive oil
in their diet.
 Have healthy carbohydrates- like unprocessed or least processed
whole grains, vegetables, fruits and beans.
 Avoid bad carbohydrates- like refined flour and sugar, white
bread, pastries, sodas, and other processed or refined foods.
They get converted into triglycerides- the type of fat which gets
accumulated into liver.
 Avoid bad fat- these are saturated fats and trans fats. Thus avoid
high fat meat like beef, lamb, pork, chicken with skin, whole fat
dairy products, butter, cheese, ice cream, lard etc. Cut back on
trans-fats by avoiding commercially baked pastries, cookies,
muffins, cakes, dough nuts, packaged snacks like crackers and
chips, stick margarine, vegetable shortening, fried foods, candy
bars etc.
About disease
 Alcoholic liver disease is a term that encompasses the liver
manifestations of alcohol overconsumption, including fatty liver,
alcoholic hepatitis, and chronic hepatitis with
liver fibrosis or cirrhosis.
 Symptoms:-
Loss of appetite
Nausea and vomiting
Abdominal tenderness
Fever, which is often low-grade
Fatigue and weakness
Weight loss
Non Pharmacological Treatment
• AVOID ALCOHOL INTAKE.
• SMOKING CESSATION.
• DAILY NUTRITION CONSIDERATIONS:
1. EMPHASIZE MULTIPLE FEEDINGS INCLUDING BREAKFAST AND NIGHT
TIME SNACK.
2. REGULAR ORAL DIET WITH INCREASED DIETARY INTAKES (11.5G/KG/DAY
PROTEIN, 35-40KCAL/KG/DAY FOR ENERGY)
3. FLUID AND VITAMIN REPLACEMENT IF DEFICIENT
• CONTROLLING THE OBESITY IF OVER WEIGHT.
• INCREASE EXERCISE.
• TAKE ANTIOXIDANTS LIKE CITRUS FRUITS CONTAINING VITAMIN C.
• TAKE VITAMIN A & E CONTAINING DIET AS IT CAN CAUSE LIVER DAMAGE.
• IRON CONTAINING FOOD.
• LOW FAT DIET.
a n k
T h
y o u

Alcoholic Liver Disease: ICD Code:-K70.10

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Alcoholic liver

BP mmHg 160/1 130/9 160/9 140/9 160/9 150/7 160/9 130/7

Direct bilirubin 0-0.20 mg/dl 4.3 3.9

SGOT 2-31 IU/L 56 42

Albumin 3.5-5.2 g/dl 2.2 2.5

Final Diagnosis:-alcoholic liver disease

Inj. Vit k Vitamin K 2 mg IM OD

Tab. Rifagut Rifaximin 40mg PO TDS

Tab. Ciplar Propranolol 40 mg PO OD

Tab. Dytor Torsemide 40 mg PO OD

Inj. Ceftriaxone Ceftriaxone 1 gm IV BD

Syp. Lactulose Lactulose 2 tsp PO HS

Cap. Cyra -D Rabeprazole + 40 mg PO OD

Powder Protimax Protein 1 tsp PO TDS

Tab. Thiamine Thiamine 100 mg PO OD

Inj. Pantop Pantoprazole 40 mg IV OD

Inj. Emset Ondansetron 4 mg IV TDS

Inj. Amlog Amlodipine 5 mg OD OD

Cap. Cyra- D Omit

1.Silymarin (160-800mg,TDS) 2ND LINE When the symptoms are

Liver transplantation 3RD LINE End stage

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