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  • Author or Editor: Pankaj Jain x
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Abstract

Plummer-Vinson syndrome (PVS) comprises a triad of iron deficiency anemia, dysphagia and esophageal webs. Its occurrence in association with celiac disease which presents as iron deficiency anemia, has rarely been reported [1, 2]. We describe a 59-year-old female with PVS whose iron-deficiency anemia was due to celiac disease.

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Abstract

Acute pancreatitis (AP) and peripartum cardiomyopathy (PPC) are rare complications during pregnancy and can lead to high maternal mortality and fetal loss. We report a case of a 34-year-old multigravida at 36 weeks gestation diagnosed to have AP who delivered a cyanosed fetus. Subsequently, she developed PPC and recovered on conservative treatment.

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Autosomal dominant polycystic liver disease (PCLD) is a systemic hereditary disorder associated with cyst formation in the ductal organs like kidney and liver. Portal hypertension as a presenting manifestation is very rare. We report a case of 58-year-old male with PCLD presenting with portal hypertension and impaired hepatocellular function, managed conservatively.

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An elderly man with a longstanding history of hypertension on hydrochlorthiazide 25 mg and enalapril 5 mg once daily for the last seven years, presented with acute abdominal pain and diagnosed to have acute pancreatitis. Other causes of the disease were ruled out. After cessation of anti-hypertensive drugs (hydrochlorthiazide and enalapril) his condition improved and the amylase level normalized. He was started on amlodipine 10 mg/day. The patient was asymptomatic at follow-up examination and has not had another episode of pancreatitis during the subsequent six months.

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Pancreatic carcinoma (PC) manifests late in the course of disease. The lack of early symptoms leads to delay in diagnosis. Acute pancreatitis (AP) presentation of PC is reported in case series and reports. We report the first case of PC in the Indian literature, who initially presented with AP but in view of weight loss and persistent pain was diagnosed as adenocarcinoma of pancreas six months later.

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Amyloidosis involves the liver frequently but apparent clinical hepatic dysfunction is unusual. We report two patients of primary hepatic amyloid with severe cholestatic jaundice, who had rapidly deteriorating liver involvement. The mean survival was 1 month from the onset of jaundice.

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Caustic ingestion continues to be a worldwide problem in young children and adults with suicidal intent. In developing countries its incidence is still high. In the majority of the patients, it involves the esophagus and stomach. We report a young patient who presented with acute corrosive ingestion and developed pancreatitis after 10 days of ingestion. She responded to conservative treatment. At 3 weeks she developed duodenal stricture and underwent feeding jejunostomy.

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Abstract

Multiple myeloma (MM) presenting as ascites [1] and elevated amylase, lipase [2] is rare. We report a case of 57-year old female, with known Type 2 Diabetes mellitus presenting with fever, abdominal distension and elevated amylase, lipase diagnosed to have multiple myeloma with a rapid downhill course.

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Celiac disease (CD) is a malabsorptive condition of the small intestine that presents clinically with episodic or nocturnal diarrhea, flatulence and weight loss [1]. It has been increasingly recognized that CD does not always present in the traditional fashion but instead may present with elevated hepatic transaminase level [2] or with iron deficiency anemia, growth retardation, osteoporosis, infertility and menstrual disturbances [3]. CD results from an inappropriate T-cell mediated response against ingested gluten. CD frequently is associated with autoimmune diseases including diabetes mellitus, autoimmune thyroid diseases, Sjögren’s syndrome, autoimmune hepatitis, autoimmune atrophic gastritis and Addison’s disease [4]. The association of CD and hepatitis C is not established presently. We present three cases of CD with hepatitis C as case series.

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Aim and objective: To determine the efficacy and safety profile of corticosteroid on the clinical course of prolonged intrahepatic cholestasis due to acute hepatitis A. Method: We prospectively studied patients of acute hepatitis A with prolonged cholestasis (more than 12 weeks with debilitating symptoms in the form of anorexia, weight loss and pruritis disturbing night sleep) over a period of five years. The patients were randomly assigned to two groups of ursodeoxycholic acid and prednisolone (Group A) and ursodeoxycholic acid and placebo (Group B). They were assessed for cumulative mean decrease in bilirubin at day 3, 7 and then weekly till normalization of bilirubin. Quality of life was assessed in both groups on the basis of pruritis, anorexia, performance status improvement and work hour loss in days. Results: Out of 84 patients of acute hepatitis A, 21 patients had prolonged cholestatic hepatitis. Eleven patients (group A) were given ursodeoxycholic acid and prednisolone. Ten patients (group B) were given ursodeoxycholic acid and placebo. In group A, male: female ratio was 7:4, with a mean age of 21 years (range 13–30 years). The mean bilirubin was 29.4 mg/dl (range 24.9–34.6 mg/dl), aspartate aminotransferase (AST) 104 (range 84–124 U/L), alanine (ALT) aminotransferase 74 U/L (range 51–98 U/L), alkaline phosphatase (AP) 643 (range 460–870 U/L), prothrombin time (PT) prolongation in seconds 3.09 (range 4–7) and protein/albumin 7.1/4.2 (range 7.6–6.4/3.6–4.7 gm/dl). The decrease in bilirubin in group A (cumulative mean) at day 3, 7, 14, 21, 28, 35, 42, 49 was 20.1%, 45.6%, 58.6%, 64.6%, 71.7%, 76.1%, 80.5% and 86.4%, respectively. The mean time for bilirubin normalization was 44 days (range 28–84 days). In group B, male: female ratio 5:5, with a mean age of 21.5 years (range 11–35 years). The mean bilirulin, AST, ALT, AP, PT prolongation (in seconds) protein-albumin were 28.6 (range 11–35 mg/dl), 81 (range 43–112 U/L), 64 U/L (range 39–91 U/L), 702 (range 326–890 U/L), 3.6 (range 2–7) and 6.57/3.7 (range 7.6–5.8/3.2–4.2 gm/dl), respectively. The decrease in bilirubin at day 3, 7, 4, 21, 28, 35, 42, 49 was 2.1%, 5.9%, 11.9%, 19.1%, 25.1%, 29.3%, 33.3% and 38.5%, respectively. The mean time for bilirubin normalization was 94 days (range 74–138 days). p < 0.05 at day 3, 7, 14, 21, 28, 35, 42 and 49 days. Pruritis responded within a mean of 5 days (range 4–8 days) and 24 days (range 18–45 days) in group A and group B, respectively. Anorexia, performance status improvement occurred early in group A and work hour loss was more in group B. None of the patients developed side-effects to corticosteroid. Conclusion: Both groups of prolonged choleastatic hepatitis A were of comparable severity in term of maximal serum bilirubin and transaminases. Prednisolone resulted in symptomatic relief and a rapid initial drop in serum bilirubin levels followed by a persistent fall. No adverse event was recorded. So, prednisolone can be used in debilitating symptoms due to cholestasis in acute viral hepatitis A.

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