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Abstract: The patient in this case had primary biliary cholangitis, which was diagnosed at a young age and was well controlled. However, with increasing age, the disease caused increasing biliary stasis, which led to cirrhosis of the liver. This time, the patient was admitted to the hospital because of weakness and poor digestion. After hospitalization, it was found that hypersplenism caused more severe anemia and also poor liver function, and the patient was given blood transfusion therapy + medication, and after aggressive treatment, the patient’s liver function improved and her general condition improved.
Basic information】Female, 55 years old
Disease Type】Primary biliary cholangitis
Hospital】Liaocheng People’s Hospital
Consultation time】November 2021
Treatment plan】Intravenous blood transfusion + medication (human albumin, diammonium glycyrrhetinate injection, ursodeoxycholic acid tablets)
Treatment Period】Hospitalization for 2 weeks, regular review
Effectiveness of treatment] Liver function improved, general condition improved
I. Initial consultation
This patient has been diagnosed with primary biliary cholangitis for many years, and her main symptoms were weakness and poor digestive function. However, this disease is irreversible, and the degree of cirrhosis will become more and more serious. The main reason for this patient’s visit was the occurrence of hypersplenism, resulting in anemia, low platelets, and combined with liver insufficiency, and the patient was admitted to the hospital in order to improve his general condition.
II. Treatment history
After admission, routine blood tests were performed, and the hemoglobin was 70 g/L, which was moderately anemic. Therefore, the patient was given blood transfusion therapy and intravenous infusion of red blood cells. The liver function check revealed a mild increase in transaminase and bilirubin, but the level of albumin was low, which was a state of liver insufficiency. By actively correcting the patient’s general condition, the hemoglobin level gradually increased and the albumin level also gradually increased, and the patient’s general condition gradually improved. However, the main cause of the above symptoms was hypersplenism caused by primary biliary cholangitis and combined with hepatic insufficiency. Later, the patient underwent intensive CT examination, and it was found that the patient’s liver showed cirrhosis and liver atrophy, accompanied by splenomegaly and hypersplenism (as shown in the figure), and if he wanted to solve the above problems completely, he should undergo liver transplantation.
III. Treatment effect
After the patient was admitted to the hospital, he was given blood transfusion, human albumin transfusion, liver protection and biliary treatment. The patient’s anemia improved, albumin was close to normal, transaminases and bilirubin were also close to normal, and the general condition improved significantly. The patient’s physical strength was restored, and he gradually resumed eating, and the amount of food he ate gradually increased. However, after the patient is discharged from the hospital, if the disease is not well controlled, the symptoms are especially prone to recurrence. Therefore, before discharge, the patient is advised to observe his condition in time, and if there is any abnormality, seek medical follow-up in time.
IV. Precautions
A high number of patients have improved their symptoms after active treatment, but adjustments in their daily lifestyle are equally important and require attention to.
1, diet, light, easy to digest food, avoid eating raw, hard, spicy and irritating food. Raw, spicy and irritating food may lead to rupture of blood vessels in the esophagus and fundus of the stomach, which may result in gastrointestinal hemorrhage. In addition, nutrition should be strengthened and high-protein foods, such as lean meat and fish, should be consumed to enhance resistance and promote recovery from the disease.
2. In life, more attention should be paid to rest, as the patient currently has anemia and is not suitable for excessive and overly strenuous activities.
3, regular medical consultation, review blood routine, liver function, if the state of liver function is not good, it is recommended under the guidance of the doctor symptomatic treatment.
V. Personal insight
Primary biliary cholangitis, also known as primary biliary cirrhosis, is a congenital disease with no clear cause and belongs to a kind of autoimmune hepatitis, for which there is no special medicine to cure. This disease can gradually cause cirrhosis, which brings a series of complications. If you want to cure it, you should consider liver transplantation, but the cost and the psychological pressure on the patient is very high. As in this case, the patient is hesitating whether surgery is needed. From the doctor’s point of view, I myself recommend surgery, but the financial and psychological pressure cannot be ignored. Therefore, even if the patient is treated conservatively, I will still make my best efforts to minimize the impact of the condition on the patient.