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Abstract: This is a case of a 35-year-old Mr. Sun, who had a history of hepatitis B. He drank small amounts of alcohol intermittently, and in the past month, he developed intermittent weakness, loss of appetite, occasional aversion to oil, nausea, and progressive skin yellowing. He was diagnosed with chronic liver failure and was given medication, and his liver function gradually returned to normal.
Basic information】Male, 35 years old
Disease Type】Chronic liver failure
Hospital】The 988th Hospital of the PLA Joint Logistics and Security Forces
Date of consultation】March, 2020
Treatment plan】Medication (glycyrrhizin tablets, enteric capsules of hepatocyte growth promoter, cefazoxime sodium for injection, entecavir capsules, spironolactone tablets, furosemide tablets)
[Treatment period] 6 weeks of inpatient treatment, 4 weeks of home treatment, 3 years of follow-up
Treatment effect】The disease has been controlled, the indicators have recovered, clinical cure
I. Initial consultation
Yesterday, a male patient with obvious yellow skin staining and significant weakness came to the clinic with self-suspected liver problems. After inquiry, the patient had liver disease in the past, and had stomach discomfort for some time, but did not care about it after taking medication, and drank alcohol twice when he felt tired due to recent night shift, about 1 tael each time. Recently, he had yellow skin staining and yellow urine, so he came to the clinic with suspicion of health problems. The patient was found to be positive for hepatitis B markers at the age of about 13 years old, during which he had normal liver function, normal virus quantification, and no significant abnormalities in liver ultrasound, so he gradually ignored the matter and did not review it again in recent years. Now he is married and has children, one son and one daughter do not have hepatitis B. The patient is tired because of his work and likes to drink after the night shift. Physical examination: the patient’s skin and sclera were moderately yellowish, hepatic palms were visible, no spider nevus was seen, the abdomen was not palpable under the ribs of the liver, the spleen was palpable under the ribs 3 cm, the quality was medium, no tenderness, the abdomen was positive for mobile turbid sounds, the pressure pain and rebound pain around the umbilicus was positive, and there was no obvious edema in both lower limbs. According to the patient’s medical history, symptoms and signs, chronic liver failure was now considered, and liver function, renal function, blood routine, hemagglutination four, abdominal ultrasound and other examinations were immediately performed. The results showed: TBIL: 354.8 μmol/L, DBIL: 221.1 μmol/L, ALT: 346 U/L, AST: 138 U/L, ALB: 33.2 g/L, GLO: 22.8 g/L. The five small triplets of hepatitis B showed: HBV-DNA: 5.24E +05copeis/ ml. The routine blood tests showed: low white blood cells and platelets, serum pre Abdominal ultrasound showed diffuse liver damage, thick and hairy gallbladder wall, large spleen, solid nodules at the splenic hilum, and fluid in the abdominal cavity.
II. Treatment history
The patient presented with intermittent weakness, loss of appetite, occasional aversion to oil, nausea, and progressive skin yellowing in the past month. Detailed medical history was taken in the past six months, and the patient had intermittent weakness and loss of appetite, no anorexia and nausea in the early stage. Nutritional support and plasma replacement, spironolactone tablets combined with furosemide tablets for diuresis, and a comprehensive regimen of symptomatic treatment. While fully informing the patient of the risks and criticality of his condition, the treatment plan was initiated after full communication with the patient and his family. After 3 days of treatment, the patient felt that his appetite had increased, and the symptoms of oil aversion and nausea had been significantly reduced. The patient and his family were worried about infecting his family, especially his children, so they explained to the patient and his family that the patient’s children and loved ones had been vaccinated against hepatitis B and had protective antibodies, so they would not be infected with the disease. The patient will not be infected.
III. Treatment effect
After 6 weeks of strict bed rest, control of liver inflammation, promotion of hepatocyte regeneration, anti-infection, diuretic and antiviral treatment, the patient’s liver function gradually improved, malaise and other uncomfortable symptoms disappeared, appetite returned to normal, abdominal infection was controlled, ascites was eliminated, liver function was basically normal on recheck, virus quantification was normal, and the patient’s mental and physical strength also returned to normal. At the same time, the patient was instructed to pay attention to rest, take medication on time, come to the hospital once a week to review liver function, blood routine, HBV-DNA, abdominal ultrasound and other indicators, and continue to strengthen the control of liver inflammation, anti-liver fibrosis, antiviral treatment. At the same time, pay attention to rest, regular rest and rest, pay attention to diet with high protein, high vitamin and low fat, enhance the body’s ability to resist disease, abstain from alcohol, avoid spicy and cold food, and forbid the consumption of drugs that are damaging to the liver. The disease mostly develops on the basis of chronic liver disease, if the patient does not continue antiviral and control liver inflammation and anti-fibrosis treatment after clinical treatment improves, the disease is prone to recurrence after drinking alcohol, exertion and discontinuation of antiviral drugs, so the patient is followed up for a long time, after long-term follow-up, the patient’s condition is stable so far, and it is advised that if there is malaise, loss of appetite and other discomfort, it is necessary to actively go to the hospital and speak with the doctor to avoid If you have any discomfort such as weakness and loss of appetite, you should actively go to the hospital and talk to the doctor to avoid missing the diagnosis and delaying the disease.
IV. Notes
We are glad that the patient’s condition has been controlled after treatment. Since the patient knew that he had a past history of hepatitis B, he consulted the infection department directly and made a clear diagnosis in a timely manner, and the treatment is now working well. However, attention should still be paid to the following conditions to prevent relapse and progression of cirrhosis.
1.Continue to pay attention to rest and avoid exertion.
2.Continue to strengthen the control of liver inflammation, anti-viral and anti-fibrosis treatment.
3.Maintain a good state of mind, quit smoking and drinking, do not stay up late, avoid straining and regular rest and recuperation.
4, pay attention to their own discomfort symptoms, if there is weakness, loss of appetite and other uncomfortable symptoms, promptly seek medical follow-up.
5, the first six months 1-2 months to review once, after the indicators are stable at most not more than six months to review once.
V. Personal insight
Liver failure generally develops mostly on the basis of chronic liver disease, firstly, hepatitis virus, followed by drugs and hepatotoxic substances, such as ethanol and chemical agents. In this case, the patient had no obvious discomfort symptoms, with gastrointestinal discomfort symptoms as the first manifestation, but due to the understanding of their condition to the infection department, while more patients seek early consultation in the gastroenterology department to improve the gastrointestinal symptoms, thus leading to delay in the best diagnosis and treatment of the disease. If this disease is detected early, it can well improve the clinical treatment rate. Therefore, if there is a chronic liver disease basis cannot be careless, and regular review is needed to prevent the disease from progressing unknowingly. Such patients are advised to seek medical attention at regular hospitals promptly if they have symptoms of malaise, loss of appetite and other discomfort.