Oesophageal Varices

Topics: Liver, Hepatic portal vein, Vein Pages: 13 (4075 words) Published: January 21, 2013

MDP 30310
SESSION 2012/2013


MATRIC NO: 26833

Patient’s data
Name : Sandia ak Sagar
Age : 53 years old
Sex : Female
Race : Iban
Religion : Christian
Occupation : Housewife
Origin : Song, Kapit
Date of admission: 2nd January 2013
Date of clerking : 3rd January 2013
Chief complaint: Abdominal pain for 1 day prior to admission. History of presenting illness
Mdm Sandia with a known case of liver cirrhosis and upper gastrointestinal haemorrhage due to oesophageal varices 14 years ago presented with abdominal pain for 1 day prior to admission. The pain started at night, around 8pm in which it is sudden in onset. The duration of the pain was about 1 hour. She described the pain as distension or a bursting feeling of pain. At first, the pain was generalized abdominal pain but as the pain become progressively severe, the maximal intensity of the pain was mostly felt at the epigastrium region and at the umbilical region. She massaged her abdomen and applied some oil medication to relieve the pain. The pain was relieved for 5 minutes. After 5 minutes, she started to feel the pain again but on admission the pain had gradually lesser and subsided. Sometimes, the pain will also be relieved every time she farts/flatus. However, there were no exacerbating factors that make the pain become worsen. There is no radiation of the pain and no referred pain. But, the patient can still sleep that night because the pain has become lesser. The patient also complained of dizziness and mild headache. However, there were no shortness of breath, no palpitation, no vomiting of blood, no passing of black-tarry stool and no altered of consciousness.

The patient also had passed loose stool which immediately after the abdominal pain started. She had episodes of diarrhoea for 5 times that night. The color of the stool was yellowish in color in which the amount was about 100ml for each episode. There were no mucus noted, no blood in the stool, no pain during passing out the stool. She had feeling of nausea but no vomiting and no fever. According to her before she had abdominal pain and diarrhea, she took rice with vegetables and tea for her dinner that night. But there were no other family members presented the same symptoms as her. Madam Sandia was diagnosed with liver cirrhosis and upper gastrointestinal haemorrhage due to oesophageal varices secondary to portal hypertension 14 years ago. She was previously well with no known disease. On further questioning regarding the liver cirrhosis, she had a history of abdominal trauma with liver trauma 14 years ago in which she felt down from the 10-step stairs outside her house and she landed on a big stone. To be more specific, she landed on the ground with her abdomen had a much greater impact with the stone which is slightly larger than her abdomen. Immediately after that, she had loss of consciousness and regain consciousness after few minutes. But she refused to go to the hospital immediately because she thought she only had minor injury. Few days later, she started to develop fever in which she took paracetamol to relieve the fever. The fever did not resolve and 2 weeks after that, all of a sudden, she vomited out blood with food particles and pass out dark-tarry stools. Her family members also noticed her had become more lethargic, weak and some skin bruising. She also noticed yellowish discolorations at her whole body. Her family immediately brought her to the hospital and she was transfused with 6 pints of blood because she is anemic. She was admitted for 2 weeks for further treatments and managements. Endoscopy was done and showed ruptured oesophageal...
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