Post on 14-Apr-2018
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welcome
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ByDr. Bhavin Kathiriya2nd yr p GDept. of Kayachikitsa.
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Name : Sumit trivedi
Age : 35 yrs
Sex : male
Address: Kolkatta, W.Bengal
Marital status: Married Occupation: Software Engineer
I.P.No: 76912
Date of admission : 02/07/12
Date of discharge : 26/07/12
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Pt c/oLow back pain since 10 years, stiffness in the back
Inequality in the length of both legs( left leg incresed by 2inch.) since 2 years. Sometime c/o. pain in both shoulder
joints and right hip joint.
.
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Piles since 2 years
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Patient named of Sumit ,aged 35 was apparentlyhealthy 9 years back. Gradually in the september 2003he started having pain in low back and left sacroiliacjoint. For this he started taking pain killer.
Later in 2004 even after taking pain killer, he couldntfind relief. So he approached a doctor where he wasdiagnosed he is suffering from ankylosing spondylitisHLA_ b27. He was advised NSAID and certainexercise. He started taking tablets but didnt do theexercises. And the interval of pain started reducing to2 month.
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In 2008 september, he stopped all conservative medicineand started doing accupressure for 6 months but during
this his pain aggravated. Now he started having pain inthe cervical region radiating down also in the spine. He,now also have stiffness in the spine also.
In 2009 January, he stopped accupressure treatment and
came to sdm udupi for ayurvedic
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treatment under Dr. Muralidhar Sharma Sir. He wasgiven basti, agnichikitisa lepa, kaishor guggulu. But he
couldnt appreciate much change so he stopped thetreatment and again started with pain killer.
During this time he also developed the deformity in lefthip joint due to which his range of movements were
markedly diminished and their was inequality in lengthof two legs. The left leg became longer than right.
But finding it harmful for the body he thought to takeayurvedic treatment once again so he came to our
hospital on 2nd july 2012.
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Nature of pain: diffused, pricking
increases in the morning
Interval : 3 months Duration: 1 week
Aggravating factor: not specific
But he has observed that pain that episode of pain
increases in winter
Relieving factor: analgesics
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No history of fever, gastric disturbance,
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No significant past history is recorded. Patient is nondiabetic and non hypertensive
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Not a known case of diabetes mellitus andhypertension
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All family members are said to be healthy (wife and 2 daughter).
Father and mother stay together.
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Appetite : Good
Diet: mixed
Sleep : Normal (7 hrs night )
Bowels : (once/ day, constipated)
Micturition : 5-6 times /days Habits : alcohol : Ocasionally
Smoking : 5-6 cigarats/day priviously (stopped since 2011 )
Tea: 2 times/ day
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Appearance - Normal
Built - NormosthenicNutrition - Moderatly nourished
Cyanosis - abPallor - present
Icterus - presentOedema - pedal edema; non pitting typeHeight - 169cms
Weight - 75 kgTongue - coatedLymphadenopathy- abGait - limphingSpeech - intact
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Temp - 98.6*F
Pulse - rate 78/minResp rate - 22/minB.P - 130/90 mm of Hg
J.V.P. - not raised.
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CVS EXAMINATION-
S1 & S2 heard , no added sounds..
RESPIRATORY SYSTEM EXAMINATION-
Normal vesicular breath sounds, no creps , No added sound.
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HIGHER MENTAL FUNCTIONS: Intact.
Cranial Nerves- Intact
Motor and Sensory system- Intact
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INSPECTION
Distension of abdomen present
Scars : absentStriae :absentDialated vein : absentRashes : absent
Umbilicus : invertedContour of the abdomen: symmetrical
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COMPLETE BLOOD COUNT
Hb 10.5 gms%
WBC 16500 cells/cumm17300 ( 2/7/12)
ESR 54 mm/hr84 ( 2/7/12)
DIFF. COUNT OF WBC
N 80%
L 16%
Eosinophils 4%
Monocytes 0%
Basophil 0 %
Total RBC 2.9 millions /cumm
Platelet count 2.6lakhs / cumm
PCV (Hct) 32 %
MCV 108 fl
MCH 35.5 pg
MCHC 32.8 gms %
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Random Glucose : 71 mg/dl ( 60 -140 ) Blood Urea : 12 mg/dl (10-50)
Serum creatinine : 0.6 mg/dl (0.6-1.4)
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Total bilirubin 16.2 mg/dl
Direct Bilirubin 9 mg/dl (0-0.3)
Indirect Bilirubin 7.2 mg/dl (0-0.9)
SGOT 154 U/L ; 152 (2/7/12)SGPT 61 U/L; 74
Alkaline Phosphate 139 U/L
Total Protein 7.2 g/dl
Albumin 3.2 g/dl
Globulin 4 g/dl
A/G Ratio 0.8
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Negative ( 25/06/12 )
Negative
Negative
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Alcoholic liver disease? Cirrhosis
? Regeneration modules/ HCC in the left lobe
Mild Splenomegaly
? Portal hypertension G.B. sludge
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27/06/2012
Features suggest the possibility of cirrhosis of liver withmoderate Ascites and Minimal left Pleural effusion.
cirrhosis of liver
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JAUNDICE WITHdistension of abdomen
& pedal oedem
PRE HEPATIC
ANEMIA , FEBRILEILLNESS ,
NO BLEEDING
HEPATIC
HEREDITARY
GILBERTSSSUNDROME
INFECTIVE
HEPATITIS
CHRONIC
ALCOHOLINDUCED
DRUG INDUCED
POST HEPATIC
CLAY COLOUREDSTOOLS,
COLICY ABDOMENPAIN
MURPHYS SIGN
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Clinical diagnosis - Jaundice
Anatomical diagnosis - Hepatitis
Etiological diagnosis - Alcohol induced Hepatitis
Pathalogical diagnosis-Alcohol induced Hepatitis
( cirrhosis of liver with moderate Ascites )
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I/O chart
Inj. Lasix 40 mg iv stat
Tab. Lacilectone 1-1-0
Shrikhandasava 3 tsp tid
Tab nirocil 1-1-1Shivagutika 1-0-1
Inj. Cefaday 1 gm iv BD ( till 14 dose)
Inj genta 80 mg iv BD ( 5 dose)Feeding resticted to 1500 ml / day
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Alcoholic Liver disease: Alcohol is metabolized exclusivelyby the liver.
pathway1)Alcohol Acetaldehyde
ADH
This Acetaldehyde adducts with cellular protein in
hepatocytes which activates immune system leading to cellinjury.
Alcohol when metabolized with oxidase enzyme whichconverts etanol to acetate leading to release of free radicals,leading to lipid preoxidation which induce mitochondrial
damage and there by hepatic damage .
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Nadi 78/min
Mutra vikruta (2-3 times/day)
Mala vikruta
Jivha Alipta Shabda prakruta
Sparsha Prakruta
Drik pita varna in shukla mandala
Akriti Madhyama.
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Dasa vidha pareeksha
Prakriti: pitaja-vataja (chapala gati, chestabahupralapa,
ushna asahishnuta, sheta preeyata,
guru gatra, kshuda, sweda adhikata)
Vikriti: Hetu: Ahara :- katu, ati ushna, vishama ashana,Akala ashna
Vihara:- ati shrama, ati madya sevana,
Ratri jagarna
Manasika:- Ati vishada, Ati chinta Dosha:- Tridoshaja ( pita ulvanata)
Dhatu:- Rasa, Rakta, Mamsa, Medas
Desha:- Aanupa
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Kala:- Aadana kala
Bala:- Madhyma
Vyadhi bala:- Madhyma
Saara:- Avara(Madya has all opposite gunato ojas , so on long standing drinking of
madya leads to ojo kshaya and thus saptadhatu saara will be kshaya)
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Samhana:- Madhyma
Pramana:- madhyma
Saatmya: madhyama
Satva: avara
Ahara shakti:- Madhyma
Vyama Shakti:- Madhyma
Vaya: Madhyama
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Nidana:Ahara :- katu, ati ushna, vishama ashana,
Akala ashna
Vihara:- ati shrama, ati madya sevana,
Ratri jagarna
Manasika:- Ati vishada, Ati chinta Poorvaroopa: Aruchi, Annanabhilasha, chhardi in
morning before brushing
Roopa. Pita varna in netra and mutra, ishat pitata
in hasta, udara, shotha in pada. Manda jvara, alpa muutrata, atisara
Upashaya anupashaya: nothing specific
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Ati madya. Ati katu ahara, vishmaashana, ati shrama, ratri jagrana
chinta
pitta pradhan dushti with tridoshadushti
Agni dushti
Agni mandhya producingaam
Circulation of saama dosha withrakta)
Raktavaha sroto dushti
Adhika rakta mala utapatti
Circulation of raktamala(pitta) with rakta
Sthana samshraya in moola of rakta
and mamsa causing rakta mamsadushti
KAAMALA(Koshtha ashritakamala)
KUMBHKAMALA
Kalantar
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Dosha: Tridosha (pitta pradhan- pachaka,
bhrajaka, alochaka,vata- vyana, samanakapha- kledak)
Dushya: rasa rakta mamsa medas Updhatu twak Mala mutra, purisha Agni: jatharagni , dhatvagni Agnidushti manda Srotas: rasavaha, raktavaha, annavaha
Srotodusthi: sanga, vimarga gamna Udbhava sthana: amashaya Sancharasthana koshta Vyakta sthana: tvak, netra, mutra, koshta Rogamarga: Bahya and Abhyantra.
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Shakha ashrita kamala Halimaka
Pittaja madatya janaya kumbha kamala
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Disease Inclusion Exclusion
Shakha ashrita kamala Haridra mootra, netra,twak, avipaka,agnimandhya
Kapha vata prakopna ispathology.Vishtabdhata, swetavarchas
Halimaka Pita varna, bala kshaya,mrudu jvara
Daha, trishna, utsahakshaya
pittaja madatya janaya
kumbha kamala
Jvara, atisara, haridravarna of tvak
Pita varna of netra, tvak,nakha, mutra, purishashotha
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Pittaja madatya janya kumbha kamala
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Patient is a shop owner. He works for 16 hours i.e. ativyama and sleeps for 5hrs in night on long run leads tovata vridhi.
He has habit of consuming ati tikshna, katu aaharawhich vitiate pitta in patient.
Patient has habit of consuming madya since 15 years.
According to acharya charaka in chikitsa sthana 24th
chapter explains that all madyataya are tridoshajanaya. Their could be either
One dosha ulvanta
Two dosha ulvanta Vrudha, vrudhatara and vrudhatama
Sama sannipata
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Madya has all opposite gunas to ojas and same guna tovata thus it does the kshaya of ojas and vridhi of vata.
. ./
Person has which increase rajas and which
in turn increase pitta in body. - . .
Thus we see the vitiation of all the three doshas .
is (.. )
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is a . . . .. Koshtashrita kamala is bahu pittaja vyadhi.
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the patient should be given abhyantara snehapana with
panchgavya ghruta, mahatiktaka ghruta and after that mruduvirechana should be done.
Virechana can be given with trivrut kalka with triphala kwatha
or danti 24 gms with 48 gms of guda
After this patient should follow diet.
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_ , ,
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