Postpartal abdominal distention

Postpartal abdominal distention

S186 Abstracts AJG – Vol. 96, No. 9, Suppl., 2001 This case emphasizes the sudden unexplainable deterioration of compensated liver cirrhosis in the...

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S186

Abstracts

AJG – Vol. 96, No. 9, Suppl., 2001

This case emphasizes the sudden unexplainable deterioration of compensated liver cirrhosis in the presence of cryptococcal infection, causing the rapid demise of patient. Cirrhotics should also be considered as severely immunocompromised and be searched for the evidence of an opportunic infection, e.g. cryptococcal infection, in the case of sudden deterioration of their compensated condition. This will be extremely crucial in liver transplant setting.

586 Abdominal pain and weightloss due to? gastric polyps TC Chauhan, MD; M Cerulli, MD FACG; I Ho, MD FACG V. Amin, MD. The Brooklyn Hospital Center, Brooklyn NY 11201 Background: Failure to evaluate patient as a whole and attributing symptoms to a trivial incidental finding often leads to undesirable outcome for our patients. Case Report: As a Primary Care Physician, I saw a 56 years lady for weight loss. She has abdominal discomfort for past six months and had dwindled from 130 to 86 pounds. Her exam was significant for cachexia and left supraclavicular node. She was already seen by a Gastroenterlogist and had EGD, Colonoscopy and Abdominal CT done. She had multiple gastric polyps, all Hyperplastic on biopsy. She even had Laproscopic Cholecystectomy without improvement in her symptoms. She was referred to University center for treatment of gastric polyps. After multiple EGDs, she had About 30 polyps removed, all Hyperplastic. Her dyspepsia was attributed to her obsessive nature. Two things tipped me off-her weight loss and palpable supraclavicular node. I arranged for her to have an ERCP done by another Gastroentrologist. She was found to have “Double Duct sign” and positive cytology due to inoperable pancreatic cancer. Teaching Points: 1. Do not attribute weight loss to psychogenic illness untill thorough workup is done. 2. Gastric Polyps are NOT known cause of abdominal pain. 3. Do not recommend Cholecystectomy without justification to cure abdominal pain. 4. Appropriate clinical evaluation should always precede any endoscopic work. 5. When evaluating patient with loss of weight with CT, Specify that you want thin cuts to visualize pancreatic tumors, if any. Reference: Pg 780, Gastrointestinal Diseases, Sleishenger, 5 th E.

587 Hepatotoxity due to yet another herbal TC Chauhan, MD; M Cerulli, MD FACG; J. Geders, MD FACG: I. Ho,. MD FACG; V. Notar-Francesco, MD FACG; W. Sohn, MD M. Reddy, MD. The Brooklyn Hospital Center, Brooklyn NY 11201. Background: Herbal preparations are known to have unpredictable and Often harmful effect on liver. This is the first reported case of liver toxicity from Chinese rice tea. Case Report: A 40 year old lady from Sri Lanka, presented with jaundice. Medical history was positive for only IDDM. She denied OTC or herbs. On exam, she had few scratch marks, but no organomegaly. Her admission laboratory work (shown in the table) was very suggestive of obstruction. An abdominal CT was normal. Liver biopsy was reported as–“Intrahepatic centrilobular cholestasis with discreet microvescicular steatosis and reactive, occasionally bineucleated hepatocytes. Portal spaces are expanded by inflammatory edema With polymorph, few eosinophils and lymphocytic infiltrate.” Test

Admission

Day 2

Day 6

Day 20

T.Bili D.Bili AST ALT ALP PT

9.2 7.4 219 408 435 15

14.2 11.2 103 269 448 18

9.0 7.4 73 141 327 17

2.0 1.3 17 26 161 13

Her liver enzymes started to normalize while she was in hospital. When she was told that her liver was damaged by some medicine or chemical, she confessed that she had been using Chinese rice tea until her admission. It contains kelp and it is claimed to improve diabetes. She promised not to use the herb again. During her follow up at week 3, her LFTs returned to near normal Teaching Point: Many medicines and herbs are known to have hepatotoxicity, but there was no reported case with Chinese Rice Tea. The clinician must be aware that any herbal preparation may have hepatotoxicity and detail and direct questions must be asked as the patient may not be aware of it.

588 Postpartal abdominal distention TC Chauhan, MD; M Cerulli, MD FACG; I Ho, MD FACG L Liang, MD FACG. The Brooklyn Hospital Center, Brooklyn NY 11201. Clinical Information: A 19 year old Hispanic female was seen in consultation by GI team to evaluate her abdominal discomfort and distention. She was 6 weeks post C-section. She had no nausea or vomiting, but mild cramps in abdomen. Due to symptoms of URI, her PMD started her on Cephelexin 500 po QID for 10 days. During the third month of her pregnancy she experienced hairless and skin rash. On exam, she had pedal edema and, fluid thrill and shifting dullness. Abdominal x-ray showed distended bowel loops and ground glass appearance. Significant labs-Albumin 2.4, LFTs and PT/PTT-normal, C.Diff⫹, ESR-20, At 5th month-C3 was 27 and C4 ⬍ 1.5 (both normal) WHAT IS YOUR DIAGNOSIS? 1. 2. 3. 4. 5. 6. 7.

Hypoalbuminemia leading to ascites Antibiotic associated C. Diff with colonic distention and ascites Primary peritonitis secondary to c-section, now masked by antibiotics Urinary ascites secondary to ureteric injury during c-section Ascites with CHF in post-partal myocarditis v/s myocarditis in SLE Serositis due SLE Exacerbation of SLE causing nephrotic syndrome/nephritis

WHAT TESTS WOULD YOU LIKE TO ORDER INITIALY? Abdominal US only confirmed ascites, ascitic tap showed abl-1.9, amylase13, BUN zero. Colonoscopy showed petechial lesions, Biopsy confirmed vasculitis. 24-hour urinary protein was normal, C3 was 42.4 and C4 was 4.4. Teaching Points: 1. C. Diff colitis is not associated with ascites, but all other conditions mentioned above needs to be considered in differential diagnosis. 2. Post-partal flare of SLE should be considered due to history of hair loss and that was her diagnosis. 3. It responds well to Prednisone and Plaquinil.

589 Fatal acute post-transfusional hepatitis C in a cirrhotic Ahmad Cheema, M.D.1, Kapil Mehta, M.D.1, Abdul Nadir, M.D.1 and D avid Van Thiel, M.D.1*. 1Gastroenterology and Hepatology, Loyola University Medical Center, Maywood, Illinois, United States. Purpose: Post-transfusion hepatitis has diminished to less than 5% in the last decade because of better screening. Usually, acute HCV is asymptomatic. Herein, we report a case of HCV that was acquired from transfusion in a cirrhotic awaiting liver transplantation in 2000. Results: This 55-year-old white male was admitted to the hospital with painless jaundice. A diagnosis of alcohol-induced cirrhosis had been established previously with a liver biopsy and absence of other liver markers including HBcAb (total), HCV-Ab (Elisa III), HCV-RNA, HBV-DNA, ANA and a normal iron saturation. He denied using any new medications, including OTCs and recreational drugs. His physical exam was significant