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Comprehensive Medical Report Analysis
Patient: T. Vishnu Vardhan Reddy | Age: 15 Years | Sex: Male
Date of Reports: 14 July 2026 | Referred by: Dr. P.S.M. Prasad, M.S., F.A.I.S (Gen Surgeon)
REPORT 1 - USG ABDOMEN (Star Diagnostics)
Findings Summary
| Organ | Finding | Status |
|---|---|---|
| Liver | 16 cm, diffuse increased echotexture | ❌ ABNORMAL |
| Gallbladder | Distended, no calculi, no wall thickening | ✅ Normal |
| CBD | Not dilated | ✅ Normal |
| Portal Vein | Normal | ✅ Normal |
| Pancreas | Normal size and texture | ✅ Normal |
| Spleen | 11.9 cm, normal | ✅ Normal |
| Right Kidney | 9.6 x 4.5 cm, normal | ✅ Normal |
| Left Kidney | 9.1 x 4.7 cm, normal | ✅ Normal |
| Urinary Bladder | Distended, no calculi | ✅ Normal |
| Ascites | None | ✅ Normal |
| Pleural Effusion | None bilaterally | ✅ Normal |
| Mesenteric Lymph Nodes | Enlarged in RIF + periumbilical, largest 19x9 mm | ❌ ABNORMAL |
Impression
- Hepatomegaly with fatty infiltration - Liver 16 cm (normal for age: <13.5-14 cm in males), with diffuse increased echogenicity consistent with fatty liver (NAFLD).
- Mesenteric lymphadenopathy - Largest node 19x9 mm (>10 mm is considered enlarged). Seen in RIF and periumbilical region.
REPORT 2 - THYROID FUNCTION PROFILE (Sai Vijaya Diagnostic Centre)
| Test | Result | Reference (12-20 yr) | Status |
|---|---|---|---|
| Total T3 | 160 ng/dL | 91 - 218 ng/dL | ✅ Normal |
| Total T4 | 11.3 µg/dL | 5.91 - 13.2 µg/dL | ✅ Normal |
| TSH | 1.9 µIU/mL | 0.5 - 4.30 µIU/mL | ✅ Normal |
Interpretation
All thyroid parameters are within normal range. Thyroid disease is effectively ruled out as a cause of the hepatomegaly or weight issues.
REPORT 3 - LIPID PROFILE + LFT (Srinivasa Hospitals Clinical Lab)
Lipid Profile
| Test | Result | Normal Range | Status |
|---|---|---|---|
| Total Cholesterol | 161 mg/dL | 150-240 mg/dL | ✅ Normal |
| Triglycerides (TGL) | 123 mg/dL | 70-170 mg/dL | ✅ Normal |
| HDL Cholesterol | 45 mg/dL | 30-60 mg/dL (Male) | ✅ Normal (but borderline low) |
| LDL Cholesterol | 92 mg/dL | 85-150 mg/dL | ✅ Normal |
| VLDL Cholesterol | 24 mg/dL | 7-35 mg/dL | ✅ Normal |
| Total Chol/HDL Ratio | 3.5 | Up to 5.0 | ✅ Normal |
| LDL/HDL Ratio | 2.0 | 0.5-3.0 | ✅ Normal |
Liver Function Tests (LFT)
| Test | Result | Normal Range | Status |
|---|---|---|---|
| Sr. Bilirubin (Total) | 0.48 mg% | Up to 1.2 mg% | ✅ Normal |
| SGOT (AST) | 26 IU/L | Up to 46 IU/L | ✅ Normal |
| SGPT (ALT) | 20 IU/L | Up to 49 IU/L | ✅ Normal |
| Alkaline Phosphatase | 85 IU/L | 25-140 IU/L (adult) / 104-390 IU/L (child) | ⚠️ Low-normal for a 15-year-old (growing child) |
Interpretation
- Lipid profile is currently within range, though HDL at 45 is low-normal and should be monitored.
- LFT is completely normal - enzymes SGOT/SGPT are not elevated despite the ultrasound showing fatty infiltration. This is characteristic of early/mild NAFLD (non-alcoholic fatty liver disease), where liver enzymes can still be normal.
- Alkaline phosphatase (ALP) of 85 IU/L is relatively low for a 15-year-old in active growth phase (expected 104-390 IU/L in children) - worth noting.
REPORT 4 - BLOOD + URINE PANEL (Srinivasa Hospitals Clinical Lab)
Electrolytes
| Test | Result | Normal Range | Status |
|---|---|---|---|
| Sr. Sodium | 144 mEq/L | 135-155 mEq/L | ✅ Normal |
| Sr. Potassium | 4.1 mEq/L | 3.5-5.5 mEq/L | ✅ Normal |
| Sr. Chloride | 101 mEq/L | 98-104 mEq/L | ✅ Normal |
Widal Test
| Test | Result | Interpretation |
|---|---|---|
| S. Typhi 'O' | 1:80 Dilution | ⚠️ Borderline - significant if symptomatic |
| S. Typhi 'H' | 1:80 Dilution | ⚠️ Borderline - significant if symptomatic |
In endemic regions (India), a titre of 1:80 is considered low/borderline. Titres of ≥1:160 for 'O' and ≥1:160 for 'H' are more diagnostic. However, 1:80 can still be significant in context, especially if the patient has fever, abdominal pain, or the titre has risen over time.
Other Biochemistry
| Test | Result | Normal | Status |
|---|---|---|---|
| Sr. Calcium | 9.6 mg/dL | 8.5-11 mg/dL | ✅ Normal |
| Sr. Creatinine | 0.84 mg% | ~0.5-1.0 | ✅ Normal |
| Blood Urea | 28 mg% | 15-40 mg% | ✅ Normal |
| Random Sugar | 81 mg% | <140 mg% | ✅ Normal |
| CRP | 05 mg/L | < 06 mg/L | ⚠️ Upper borderline |
CBC (Complete Blood Count)
| Test | Result | Normal Range | Status |
|---|---|---|---|
| Haemoglobin (Hb) | 14.9 g/dL | 13-17 g/dL (Male) | ✅ Normal |
| PCV (Haematocrit) | 52.9% | 40-50% | ⚠️ Mildly elevated |
| TWBC | 11,200 cells/cumm | 4,000-10,000 | ❌ Mildly elevated (Leukocytosis) |
| Platelet Count | 4.01 Lakhs/cmm (401,000) | 1.5-4.5 Lakhs/cmm | ✅ Normal |
| ESR | 10 mm/hr | M <10, F <15 | ✅ Normal (upper limit) |
Differential Count (DC)
| Cell Type | Result | Normal | Status |
|---|---|---|---|
| Polymorphs (Neutrophils) | 62% | 40-75% | ✅ Normal |
| Lymphocytes | 34% | 20-45% | ✅ Normal |
| Eosinophils | 04% | 0-6% | ✅ Normal (but upper normal - watch) |
| Monocytes | 00% | 0-5% | ✅ Normal |
| AEC (Absolute Eosinophil Count) | 448 cells/cmm | <500 | ✅ Normal (borderline) |
Urine Analysis
| Finding | Result | Status |
|---|---|---|
| Sugar | Nil | ✅ Normal |
| Albumin | Traces | ⚠️ Mild - needs repeat |
| Pus Cells | 4-6/hpf | ⚠️ Mild pyuria - possible UTI |
| RBC | Nil | ✅ Normal |
| Crystals | 3-4/hpf | ⚠️ Mild - monitor |
| EP Cells | 8-10/hpf | ⚠️ Elevated (normal <5) |
REPORT 5 - PRESCRIPTION (Dr. P. Anjani, Srinivasa Hospitals)
The prescription dated 14/7/2026, valid till 13/8/2026:
| Medicine | Purpose | Dosage |
|---|---|---|
| Tab Bandy (Albendazole 400mg) | Deworming - anti-helminthic | 1 tablet weekly x 2 doses |
| Cap Revidox-LB (Revital + Lactobacillus) | Multivitamin + probiotic | 1 daily x 6 |
| Tab Repromin-M | Likely iron/B12/folic acid supplement | 1 daily x 15 |
| Cap Omez-D (Omeprazole + Domperidone) | Gastric protection / prokinetic | 1-0-0 (before food) |
| Tab Meftal-Spas | Antispasmodic (Mefenamic acid + Dicyclomine) - for abdominal cramps | As needed x 10 |
| Tab Omnacortil 10 (Prednisolone 10mg) | Corticosteroid - likely for mesenteric lymphadenopathy | 1 daily x 10 |
| Syp Urisol | Urinary alkalizer | 2 tsp three times daily |
| Cap Multivitamin Gold | Nutritional support | 1 daily x 10 |
INTEGRATED CLINICAL ASSESSMENT
Primary Diagnoses / Working Diagnoses
1. Non-Alcoholic Fatty Liver Disease (NAFLD) - Confirmed
- Hepatomegaly (16 cm) with diffuse echogenicity on USG
- Normal liver enzymes (SGOT 26, SGPT 20) - consistent with early NAFLD
- Normal lipid profile - metabolic workup shows no dyslipidemia yet
- Thyroid normal - rules out hypothyroid-induced fatty liver
2. Mesenteric Lymphadenopathy
- Nodes up to 19x9 mm in RIF and periumbilical area
- Likely reactive - common in adolescents following viral/bacterial infections
- Borderline Widal (1:80) may represent background exposure or early typhoid
- Mild leukocytosis (WBC 11,200) consistent with early/resolving infection
3. Possible Parasitic Infection / Intestinal Worms
- Prescription includes Albendazole (Bandy) - strongly suggests clinical suspicion of helminthiasis
- Borderline eosinophils (AEC 448, just below 500) consistent with early/mild parasitic load
- Mesenteric nodes + abdominal symptoms fit intestinal worm infection
4. Mild Urinary Tract Changes
- Trace albumin, 4-6 pus cells, 8-10 EP cells, crystals in urine
- Urisol prescribed as urinary alkalizer - suggests crystal/urate nephropathy or early UTI
- Not severe, but warrants monitoring
KEY ABNORMALITIES AT A GLANCE
| Finding | Value | Concern Level |
|---|---|---|
| Liver size on USG | 16 cm (enlarged) | 🔴 Significant |
| Mesenteric lymph nodes | 19x9 mm (largest) | 🟡 Moderate |
| WBC | 11,200 (mildly high) | 🟡 Moderate |
| Widal S.Typhi O & H | 1:80 each | 🟡 Borderline |
| PCV | 52.9% (mildly high) | 🟡 Mild |
| CRP | 5 mg/L (near limit) | 🟡 Borderline |
| Urine EP cells | 8-10/hpf | 🟡 Mild |
| AEC | 448 cells/cmm | 🟡 Borderline |
| ALP | 85 IU/L (low for child) | 🟡 Watch |
| HDL | 45 mg/dL (borderline low) | 🟡 Watch |
| All thyroid values | Normal | ✅ |
| All electrolytes | Normal | ✅ |
| SGOT/SGPT | Normal | ✅ |
| Lipid profile | Normal | ✅ |
MANAGEMENT & RECOMMENDATIONS
Immediate Actions (Being Done Correctly)
- ✅ Deworming with Albendazole - appropriate
- ✅ Omeprazole + Domperidone for gastric symptoms
- ✅ Corticosteroid (Omnacortil/Prednisolone) for reactive lymphadenopathy
- ✅ Urisol for urinary crystals
- ✅ Multivitamin support
Additional Investigations to Consider
- Repeat Widal test in 7-10 days - a rising titre from 1:80 to 1:160+ confirms active typhoid
- Blood culture - if fever persists, to rule out Salmonella typhi bacteremia
- Urine culture & sensitivity - given pus cells and EP cells in urine
- Repeat USG abdomen in 3-6 months - to track regression of fatty liver and lymph nodes
- Fasting lipid profile + fasting glucose - in context of fatty liver at age 15 (screen for metabolic syndrome)
- Body weight and BMI assessment - fatty liver at 15 is often associated with obesity; lifestyle intervention is cornerstone of NAFLD management
- Stool examination - to confirm/exclude worm infestation if not already done
Lifestyle Advice for NAFLD (Most Important Long-Term Issue)
- Dietary modification: Reduce refined carbohydrates, sugary drinks, fried/fast food
- Increase physical activity: At least 60 minutes of moderate aerobic exercise daily
- Weight management: Even 5-10% weight reduction significantly improves fatty liver
- Avoid hepatotoxic agents: No alcohol, minimize unnecessary medications
- Follow-up LFT, USG in 3-6 months
Prognosis
- With early intervention, NAFLD in a 15-year-old is fully reversible through lifestyle changes
- Reactive mesenteric lymphadenopathy typically resolves within 4-6 weeks
- Widal titres and leukocytosis should normalize with treatment
Disclaimer: This analysis is for educational/informational purposes. All clinical decisions must be made by the treating physician with full clinical context. Follow up with Dr. P.S.M. Prasad and Dr. P. Anjani as scheduled.
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