PBL 6 session 2

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PBL 6 session 2 by Mind Map: PBL 6 session 2

1. Step 8

1.1. Diagnostic decision

1.1.1. alcoholic hepatitis (leads to liver cirrhosis)

1.2. Mechanism

1.2.1. chronic alcohol abuse lead to hepatic injury .. began with fatty liver and now it developed to hepatitis and complicated by cirrhosis

1.3. Presentation

1.3.1. jaundice

1.3.2. fatigue

1.3.3. RUQ pain

1.3.4. hot and colds

1.4. Supporting data

1.4.1. history and ohysical

1.4.2. CBC

1.4.3. serum biochem

1.4.4. US

1.4.5. CT

1.5. 10 minutes

2. Step 7

2.1. Inquiry plan and info gathering

2.1.1. History of presenting complaint 5 yrs ago he saw a GP .. liver test were up he drunk again and didn't come back to the doctor 1st time for the pain for the past month he was not able to focus in his work and was less energetic decrease in libido over the last few weeks others are negative

2.1.2. Previous medical / surgical history negative

2.1.3. Drug history / allergy no medication no allergy

2.1.4. Family history negative economic was down

2.1.5. Social / occupational history no risk factors for hepatitis travels to Europe twice a year

2.1.6. Systemic review

2.1.7. Physical examination vitals pulse 80/ min regular BP130/70 temp 37.8 BMI 22 general inspection looks tired cutaneous jaundice mild lower and upper muscle weakness mild proximal muscle wasting hands palmar erythema face scleral icterus spider neavie neck chest no gyncomastia abdomen inspection palpation percussion auscultation lower limbs cardiac apex is normal no heart sounds prephral pulses is normal respiratory negative mental normal neuro normal gait normal

2.1.8. tests results cbc heamoglobin is 10.9 g/dcl mcv is 103 fL TWC 13.8 x 10^9\ ltr neutrophill 78% lymphocyte 21 % eaosinophill 1% platlets 90 x 10^9 INR is 1.9 serum biochem c reactive protein is increased potassium is increased AST is 290 .. increased ALT 140 albumin is mild reduced .. is 30 total protein is reduced GGT is increased ALP is moderately increased total billirubin is 120 .. increased hepatitis is NEGATIVE us spleenomegaly liver is enlarged free perotoneal fluid CT macro nodular prynchemal pattern

2.2. 50 minutes

3. Step 6

3.1. Review session 1

3.2. Report new knowledge

3.3. 30 minutes

3.3.1. The scribe does not have to write in this step!