I am a 53-year-old male. Before a year, I had painless jaundice. My MRCP report showed a mass on the head of the pancreas. My endoscopic USG showed a stricture in CBD and so a stent was inserted. My bilirubin came down and Whipple procedure was planned. As my TSH was more than 20 mIU/L, it was postponed. My USG guided endoscopic biopsy revealed chronic inflammation without carcinoma. Subsequently, I developed symptoms of cholangitis due to stent block. So permanent metallic stent was placed. After that, I developed post ERCP pancreatitis.
Then it was treated conservatively. Three months back, I developed ascites and my USG showed portal vein thrombosis. I had loose stools and it stopped after taking Cholestyramine. I took a USG doppler ten days back. It showed cirrhosis. My LFT is normal except for serum albumin. Previously, all the imaging showed me a normal liver architecture. Within a month, it shows a cirrhotic picture. What is the reason for having a sudden alteration in liver structure?
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You can have two possibilities. You can have long biliary obstruction due to CBD (common bile duct) compression. It can lead to cirrhosis causing biliary cirrhosis. Any abdominal infection can cause portal vein thrombosis. It leads to have a nodular texture in the liver and portal cavernoma.
You need to do tests for knowing the levels of creatinine and electrolytes. Do ascitic fluid routine examination, serum albumin, and ascites gradient. Do HBsAg (hepatitis B surface antigen) or Anti HCV (anti-hepatitis C virus). Do PT (prothrombin time).Differential diagnosis:
You can have portal cavernoma.Treatment plan:
You can take tablet Carvedilol 6.25 mg once daily. Adjust diuretic dose. Do upper GI endoscopy and variceal banding if needed.
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