CLINICO-PATHOLOGIC CONFERENCE

GENERAL DATA
▪ 19 y/o
▪ Male
▪ Unemployed
▪ Roman Catholic
▪ Single
▪ Born on January 19, 1996

CHIEF COMPLAINT
Generalized body weakness for 10 days

HISTORY OF PRESENT ILLNESS

▪ INTERVAL HISTORY
▪ 2 YEARS PTA
▪ LLQ palpable, superficial mass
▪ Consult at a Government Hospital and Incision & Drainage was done
▪ Meds: Cotrimoxazole, Amoxicillin and Mefenamic Acid
▪ (+) Left axillary and lateral neck mass -> resolved
▪ Dx: Extrapulmonary TB (No meds given)
▪ 9 MONTHS PTA
▪ Cough, productive, whitish phlegm
▪ No consult done
▪ 6 MONTHS PTA
▪ Bipedal edema
▪ Palpable mass at right subcostal area
▪ Intermittent, undocumented fever
▪ (+) discoloration of the eyes with deep yellow urine
▪ Sought consult
▪ Dx: Kidney disease
▪ R/O Liver disease
▪ Discharged with ↓ in icteresia, edema resolved
▪ 10 DAYS PTA
▪ Generalized body weakness
▪ Recurrence of bipedal edema
▪ Yellowish discoloration of eyes and skin
▪ Intermittent fever
▪ RUQ pain
▪ Sought consult and admitted
▪ Dx: Anemia of chronic illness (t/c PTB; liver pathology)

▪ Persistence of symptom: Generalized body weakness

▪ ADMITTED

REVIEW OF SYSTEMS
▪ Had weight loss
▪ No rashes, No pruritus
▪ No visual disturbances, No hearing loss, No changes in sense of smell, No gum bleeding
▪ No cough, No chest pain, No hemoptysis, No palpitations
▪ No vomiting, No hematemesis, No diarrhea, No melena, No change in stool color
▪ No dysuria, No Hematuria
▪ No arthralgia, No myalgia
▪ No bleeding tendency, No early Bruising
 ▪ No Loss of Consciousness, No seizures

PERSONAL AND SOCIAL HISTORY

▪ Non smoker
▪ Non alcoholic
▪ Firstborn in the brood of 3
▪ Delivered via NSD attended by traditional birth attendant
▪ High school undergraduate
▪ No exposure to fertilizers, insecticides and pesticides

FAMILY HISTORY
▪ No DM
▪ No HTN
▪ No Blood disorders
▪ No Heart Disease
▪ No Malignancies

PAST MEDICAL HISTORY

▪ No HTN
▪ No DM
▪ No Asthma
▪ No Cardiac Disease
▪ No malignancies
▪ No previous hospitalizations
▪ No allergies to foods or medications
▪ Px was fully vaccinated under EPI up to 9 months

PHYSICAL EXAMINATION
General Survey:
Cachectic, Ambulatory, Conscious, Coherent
Vital Signs:
BP: 90/50 mmHg CR: 104 bpm RR: 24 cpm Temp: 36.5 oC
Skin:
Jaundiced, No Skin lesions, warm to touch, good skin turgor
HEENT:
Icteric sclerae, No tonsillopharyngeal congestion, No cervical lymphadenopathy, No neck
vein engorgement
Chest and Lungs:
Symmetrical chest expansion, No chest retractions, No tenderness, clear breath sounds,
equal vocal and tactile fremitus
Heart:
Adynamic precordium, PMI 5th LMCL, Tachycardic, Regular rhythm, No murmur
Abdomen:
Slightly globular, normoactive bowel sounds, soft, nontender, liver span 17cm measured
at midclavicular line, firm, smooth liver edge, obliterated Traube’s space
Extremities:
Pale nail beds, (-) clubbing, (-) cyanosis, (+) grade 2 pitting edema, (+1) pulses
NEURO EXAM:
MSE: Awake, conscious, oriented to 3 spheres
CN: No deficits
Cerebellar: No dysmetria, No disdiadochokinesia
Motor: 5/5 on all extremities
Sensory: No sensory deficits
Reflexes: Grade 2+ on all extremities
COURSE IN THE WARD

AT THE ER
VITAL SIGNS DIAGNOSTICS THERAPEUTICS
▪ BP: 90/50 1. CBC, Na, K, Crea, PBS, IVF: PNSS x 20gtts/min
▪ CR: 98 Retic Count, Ferritin, CXR Paracetamol 300mg/IV
▪ RR: 22 PA, UTZ, FOBT Furosemide 20mg/IV
▪ Temp: 36.9 oC 2. AST, ALT, ALP, TPAG, PT,
▪ O2 sat: 93% at room air UTZ whole abdomen
▪ Bicytopenia
▪ Jaundice

WARDS
HOSPITAL DAY DIAGNOSTICS THERAPEUTICS
CBC: Transfusion of 4 “u” PRBC
▪ HGB: 65g/L KCl drip started
▪ APC: 231
▪ WBC: 2.07
▪ G: 54.2
▪ L: 32.2
Na: 137
K: 3.1
Crea: 41.1
Protime: No coagulation after
3 min
AST: 111
ALT: 92
Retic count: 1.9%
Protein: 60
Albumin: 19
Globulin: 41
1st HD LDH, PBS, Direct and Indirect
VS: BP: 100/60 Temp: 36.9 coombs test, HBsAG, AFP
Body weakness
Icteric sclerae
Chest: clear BS
Abd: soft, nontender
3rd HD CBC: Paracetamol 300mg/IV q4h
BP: 120/90 Hgb: 119 APC: 188 Other meds continued
Temp: 39.6 WBC: 3.44
Na: 136.2
K: 3.77
4th HD CBC
BP: 100/60 Hgb: 121
T: 36.9 WBC: 2.96
Fever resolved
5th HD CBC: KCl drip started
BP: 100/60 Hgb: 109 Referred to gastro service
T: 38.8 APC: 178 UTZ of HBT w/ contrast
WBC: 3.66 Hepatitis profile
Na: 135.1 Referral to hematology for
K: 2.78 BMA
6th HD PT: 17.8s For anti HAV, GGT
BP: 100/60 72% Refer to surgery
T: 37.9 1.32 INR >whole abd CT scan
(+) body weakness PBS: Repeat CXR
(+) icterisia Smear shows mild to
(+) fever moderately hypochromic,
Chest and lungs: Fine basilar normocytic RBC morphology.
crackles There are NO nucleated RBC
seen. The WBC population is
moderately decreased
predominated by
segmenters. Platelet appears
adequate in the smear. There
are no apparent blast cells
seen

Abdominal UTZ:
Hepatosplenomegaly
Acute hepatic parenchymal
disease
Thick-walled gallbladder with
sludge formation
Normal biliary tree, pancreas,
kidneys, urinary bladder and
prostate
Minimal ascites
7th to 8th HD Hgb: 106 Repeat CBC, Na, K
BP: 110/70 Hct: 0.33
T: 37.9 APC: 204
(+) body weakness WBC: 4
▪ Neutro: 57.6
A. HAP ▪ Lympho: 36
Hepatic parenchymal disease ▪ Mono: 1.0
▪ Eosino: 1.3
Na: 135.1
K: 3.93
9th HD Hgb: 99 Repeat CBC
BP: 90/60 Hct: 0.276
(-)fever APC: 157
(+) abdominal pain WBC: 3.33
▪ Neutro: 55.3
▪ Lympho: 40
▪ Mono: 1.1
▪ Eosino: 1.7
10th HD
BP: 110/70
(+) bibasilar crackles
(+) sudden onset of chest
pain
(+) difficulty of breathing
CP arrest