45 yrs old female with well compensated cirrhosis

January 19, 2023

NOTE: THIS IS AN ONLINE E LOGBOOK TO DISCUSS OUR PATIENT'S DE-IDENTIFIED HEALTH DATA SHARED AFTER TAKING HIS / HER /GUARDIAN'S SIGNED INFORMED CONSENT. HERE WE DISCUSS OUR INDIVIDUAL PATIENT'S PROBLEMS THROUGH A SERIES OF INPUTS FROM THE AVAILABLE GLOBAL ONLINE COMMUNITY OF EXPERTS INTENDING TO SOLVE THOSE CLINICAL PROBLEMS WITH COLLECTIVE CURRENT BEST EVIDENCE-BASED INPUT.

PATIENT HISTORY: Pt is a 45 yr old female, a school teacher by profession.

Since menarche, her periods are irregular, happening 10-15 days late than expected.

In 2004, pt had accompanied her mom to a hospital for her uterine tumor Sx (mom's). During that time she was also screened for uterine tumor by Dr. USG was done which revealed gall stone. Sx was done within 2 months. Pt had no complaints or symptoms related to gallstone.

In 2004, while staying in the hospital to get her gallstone operated on, she was diagnosed with hypothyroidism. Since then on medication.

In 2007, she c/o lightheadedness while at school. Later went to a Dr. who found her to be hypertensive. Since then BP under control with medication.

In 2013, she c/o dizziness and malaise. Dr. detected DM. DM is under control with medication.

In 2019, while doing a whole-body checkup, USG was done which detected liver cirrhosis. Pt went to AIG, Dr. after doing tests prescribed atoz multivitamin tab along with another medication which she could not find, hence changed to Heptagon tab. Endoscopy was also done which detected few small polyps in fundus.

In 2021, went to Hyd to get further consultation for liver cirrhosis, USG was done and a rt ovarian cyst was detected. Also, a diagnosis of metabolic syndrome with well compensated cirrhosis of liver was made. Discharged with medications.

She c/o black hairy tongue for the past 1 yr which appears and goes away on its own within few days. She doubts on eating sour items black spots appear more.

Pt claims to be feeling all eight with no complaints.

Pt had lost wt from 85(2004) to 66(2022) kgs by controlling her diet.

Denied any history of addiction

PHYCOSOCIAL COMPONENT: (Author - Dr. Supriya)

About Patient :

She was the most lovable daughter to her Parents , She has Elder Brother (Single sibling ) Married to a Man ,who is a teacher by Occupation at the Age of 20yrs( Both are So Busy in their Profession).She has 2 children , One is 23 yr Old Male Child and other is 13 yr Old Female Child .Lovable daughter life TO Responsible wife and Mother life with Orthodox Mother in Law (with lots of Restrictions),who didnt allowed to Study further after her Intermediate ,Restricted for everything , even going outside with Husband was a big matter to her Mother in law ,later she accepted to Study further , She completed her Graduation in distance (Not regular ) , and Continued as Govt Teacher .Her Mother in law ,Passed away at the age of 93years in 2021 after 9years of bedridden life .She Used to take care of her ,Like cooking ,keeping food to her , bathing ,Changing Dress along with her Duty and Perfoming Pooja everyday (very Devotional Person ) and her Husband used to change her Diaper and clean that .

Events lead to the Present Condition : (Patient Mentioned a word - Pressure lot of times ) during Conversation.

In 2000 year- Her Husband Diagnosed with Stroke , In the Same year , she gave Birth to his First Child.

In 2007 - She was Diagnosed with Hypertension .

In 2013 - She was Diagnosed with DM 2 .

( Family History - Mother and Father were Diabetic and Hypertensive , Elder brother - Diabetic )

In 2017 - Her Father passed away ,It was a traumatic experience to her

In 2019 - She was Diagnosed with Liver Cirrhosis .(Under lot of Pressure from their Consultant doctor ,who Diagnosed her with Liver Cirrhosis and asked to arrange 30Lakhs of Rupees For Liver Transplantation)

In 2022 (October ) - Her Mother Passed away ,who was like God to her ,she was beloved one (She became Emotional and Cried while explaining about her mother ) ,that was very traumatic to her .

She had guilt of not Spending time with her Children due to her profession.

Also due to her Profession pressure ,She used to out rage over her children and later she used to feel guilty about it

Her Son, who joined Paramedical course for 2 Years ,Firstly was also a big stressor to her ,as she wanted him to become a Doctor (MBBS ). Recently, few months ago ,He joined MBBS , her stress got relieved regarding it .

If we can observe ,She was Diagnosed with something ,Every 6 years .

No Addictions (No Substance abuse ) .

Eye to Eye Contact - Maintained , PMA - Normal -During Conversation.

CHIEF COMPLAINT AND Pt REQ.: 1)Hypothyroidism and HTN since 2007

2) DM since 2013

3) metabolic syndrome with well compensated liver cirrhosis since 2019

4) ovarian cyst detected in 2021

5) black spots on tongue appearing and vanishing for the past 1 yr.

FAMILY HISTORY: Father - HTN,DM

Mom - HTN, DM, Uterus tumor Sx

Mom's cousin sisters- Uterine tumor Sx

Brother - DM