Explain to present this case
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cd /tmp/workspace/attachments/ec3d6d3b-5703-4322-9e7a-a2209858977c && python3 -c " from pptx import Presentation prs = Presentation('HEPATITIS 23PD19-1-1.pptx') for i, slide in enumerate(prs.slides, 1): print(f'=== SLIDE {i} ===') for shape in slide.shapes: if shape.has_text_frame and shape.text_frame.text.strip(): print(shape.text_frame.text) print() "
Reading File
Running Command
cd /tmp/workspace/attachments/ec3d6d3b-5703-4322-9e7a-a2209858977c && python3 -c " from pptx import Presentation from pptx.util import Pt prs = Presentation('HEPATITIS 23PD19-1-1.pptx') # Extract table data from slides for i, slide in enumerate(prs.slides, 1): for shape in slide.shapes: if shape.has_table: print(f'=== SLIDE {i} TABLE ===') table = shape.table for row in table.rows: row_data = [cell.text_frame.text.strip() if cell.text_frame else '' for cell in row.cells] print(' | '.join(row_data)) print() "
I now have all the data from the presentation. Here is a full, structured case presentation you can use to present this case confidently in your sessional exam:
Case Presentation: Hepatitis A
Presenter: V. Hemanath | 23PD09 | III Pharm.D
Institution: Karpagam College of Pharmacy, Coimbatore
Examination: III Sessional Practical - Pharmacotherapeutics IIA
1. Case Summary
A 15-year-old male patient was admitted to Karpagam Hospital on 06/12/2025 with fever for 1 week, lower abdominal pain, and vomiting for 3 days. He was diagnosed with Hepatitis A.
2. SOAP Note
S - Subjective
Demographic Data:
| Parameter | Detail |
|---|---|
| Name | Mr. X |
| Age | 15 years |
| Sex | Male |
| IP No. | 902512060 |
| Department | Paediatrics |
| Height | 171 cm |
| Weight | 42 kg |
| BMI | 14.2 kg/m² (underweight) |
| DOA | 06/02/2026 |
| DOD | 09/02/2026 |
Chief Complaints:
- Fever (evening rise in temperature) x 1 week
- Lower abdominal pain x 3 days
- Vomiting x 3 days
History of Present Illness:
The patient was apparently normal before 1 week, after which he developed fever increasing during night time, associated with chills. He had 1 episode of vomiting with food particles as content, associated with abdominal pain. History of outside food intake and headache with throat pain was also noted.
Past Medical History: Nil
Family History: Not significant
Nutritional Screening (PICCLE): All negative
O - Objective
Vitals:
| Parameter | Day 1 (06/12) | Day 2 (07/12) | Day 3 (08/12) | Day 4 (09/12) | Reference |
|---|---|---|---|---|---|
| Temp (°F) | 97.4 | 101 | 99.1 | 98.7 | 97-98 |
| BP (mmHg) | 90/60 | 110/85 | 125/90 | 115/80 | 120/80 |
| PR (beats/min) | 60 | 71 | 68 | 70 | 60-100 |
| RR (breaths/min) | 21 | 22 | 21 | 19 | 12-20 |
| SpO2 (%) | 99 | 97 | 95 | 96 | 95-100 |
Note: On Day 1, BP was low (90/60 mmHg), suggesting initial mild hypotension, possibly due to dehydration from vomiting. Temperature peaked on Day 2 at 101°F, then trended down toward normal.
Systemic Examination:
| System | Findings |
|---|---|
| CVS | S1, S2 +ve; no murmurs |
| CNS | No focal neurological deficits (NFND) |
| RS | Bilateral air entry present; no added sounds |
| Abdomen | Soft, tender |
Laboratory Investigations:
Hematology:
| Parameter | Recorded | Reference |
|---|---|---|
| Haemoglobin | 15 g/dL | 13.5-17.5 |
| WBC | 6,610 cells/mcL | 4,500-11,000 |
| Platelet count | 185,000 cells/mcL | 150,000-450,000 |
Differential Leukocyte Count:
| Parameter | Recorded | Reference |
|---|---|---|
| Lymphocytes | 56% | 20-45% (HIGH) |
| Monocytes | 8.1% | 2-10% |
| Eosinophils | 2.3% | 1-4% |
| Neutrophils | 67.8% | 40-75% |
| Basophils | 0.1% | 0-2% |
Key Finding: Relative lymphocytosis (56%) is consistent with a viral infection such as Hepatitis A.
Liver Function Tests (LFT):
| Parameter | Recorded | Reference |
|---|---|---|
| Bilirubin | 4.9 mg/dL | 0.1-1.2 (HIGH) |
| Protein | 7.1 g/dL | 6.0-8.3 |
| SGOT | 910.6 U/L | 8-45 (MARKEDLY HIGH) |
| SGPT | 1668.2 U/L | 7-56 (MARKEDLY HIGH) |
| Albumin | 3.8 g/dL | 3.4-5.4 |
| Globulin | 3.3 g/dL | 2.0-3.5 |
Critical Finding: SGOT and SGPT are dramatically elevated (>20x normal), indicating acute hepatocellular injury - a hallmark of acute Hepatitis A.
Renal Function Tests (RFT):
| Parameter | Recorded | Reference |
|---|---|---|
| Urea | 14 mg/dL | 10-40 |
| Uric acid | 3.6 mg/dL | 2.4-5.7 |
| Serum creatinine | 0.5 mg/dL | 0.6-1.2 |
| Blood urea | 14 mg/dL | 7-20 |
RFT values are within normal limits, indicating no renal involvement.
Specific Test: Peripheral smear - Normocytic normochromic blood picture with relative lymphocytosis (total WBC normal, but lymphocyte % increased).
A - Assessment
Diagnosis: Hepatitis A
This diagnosis is supported by:
- Epidemiology: 15-year-old male with history of outside food intake (fecal-oral route exposure)
- Symptoms: Fever, abdominal pain, vomiting - classic prodromal symptoms
- LFT: Markedly elevated SGOT (910.6) and SGPT (1668.2) - acute hepatocellular injury pattern
- Elevated bilirubin (4.9 mg/dL): Suggests early jaundice/hepatic dysfunction
- Relative lymphocytosis: Consistent with viral etiology
- Self-limiting course: Hepatitis A does not progress to chronic liver disease
P - Plan (Treatment)
Goals of Therapy:
Short-term:
- Reduce fever, pain, vomiting
- Maintain hydration and electrolyte balance
- Ensure adequate nutrition to support recovery
Long-term:
- Improve quality of life
- Prevent transmission and future infections
- Support complete liver recovery
Drug Treatment Chart (In-patient):
| # | Drug | Brand | Dose | Frequency | Duration |
|---|---|---|---|---|---|
| 1 | Ondansetron | EMESET (Inj) | 4 mg | SOS | 06-09/12 |
| 2 | Paracetamol | Paracetamol | 500 mg | 1-0-1 | 06-09/12 |
| 3 | Pantoprazole | PAN | 40 mg | OD | 06-09/12 |
| 4 | Ursodeoxycholic Acid | UDCA | 300 mg | 1-0-0 | 06-09/12 |
| 5 | Amoxicillin + Clavulanate | AMOXICLAV | 625 mg | 1-0-1 | 09/12 only |
| 6 | Metronidazole | METROGYL | 400 mg | 1-1-1 | 09/12 only |
| 7 | Vitamins & Minerals | FOURTS B | - | BD | 09/12 only |
Discharge Medications:
| Drug | Dose | Frequency | Duration |
|---|---|---|---|
| Amoxicillin + Clavulanate | 625 mg | 1-0-1 | 5 days |
| Metronidazole | 400 mg | 1-1-1 | 5 days |
| Pantoprazole | 40 mg | OD | 7 days |
| UDCA | 300 mg | 1-0-0 | 14 days |
| Fourts B | - | BD | 5 days |
3. Drug-Drug Interactions
| Interaction | Severity | Management |
|---|---|---|
| Amoxiclav + Metronidazole | Moderate | May increase GI adverse effects (nausea, vomiting, diarrhea); monitor GI tolerance, ensure adequate hydration |
| Ondansetron + Metronidazole | Moderate | Both prolong QT interval; risk of cardiac arrhythmia; monitor for palpitations, dizziness; use cautiously if electrolyte abnormalities |
| Paracetamol + Amoxiclav | Moderate | Both metabolized by liver; risk of hepatic impairment; monitor LFTs; avoid excessive paracetamol doses |
4. Pharmacist Interventions
-
Paracetamol caution: This is a paediatric patient with hepatitis - Paracetamol 500 mg should be used cautiously due to risk of hepatotoxicity in the context of existing liver inflammation.
-
Amoxiclav appropriateness: Amoxiclav is an antibacterial agent. Since Hepatitis A is a viral infection, its use is not indicated unless there is evidence of a secondary bacterial infection. The pharmacist recommends: if secondary bacterial infection is confirmed, Cefixime may be a safer alternative, avoiding unnecessary broad-spectrum antibiotics.
5. Drug-Food Interactions
| Drug | Food Interaction | Advice |
|---|---|---|
| Paracetamol | Alcohol increases hepatotoxicity risk | Strictly avoid alcohol |
| Fourts B (Vitamins & Minerals) | Tea, coffee, and high-fiber foods reduce absorption of minerals | Take after meals; avoid with tea/coffee |
| UDCA (Ursodeoxycholic Acid) | Fat-containing foods (milk, yogurt, eggs, nuts) improve absorption | Take with or after a fatty meal |
6. Patient Counselling
Disease-Based:
- Hepatitis A is caused by the Hepatitis A Virus (HAV) and is self-limiting - it does not progress to chronic liver disease.
- It spreads via the fecal-oral route (contaminated food and water).
- Early symptoms: fever, fatigue, loss of appetite, nausea, vomiting, headache, jaundice (yellow skin/eyes), and dark urine.
- Prolonged infection may lead to hepatic impairment - so regular follow-up is important.
Drug-Based Counselling:
- Amoxiclav: Take after food; complete the full 5-day course; report rashes or breathing difficulty immediately.
- Metrogyl (Metronidazole): Take after meals; may cause metallic taste or dizziness; complete the prescribed course.
- Pantoprazole: Take 30 minutes before breakfast; swallow whole; do not crush or chew.
- UDCA: Take after meals; supports liver function and bile flow; continue for the full duration.
- Fourts B: Take after meals; do not exceed the recommended dose.
Lifestyle Modifications:
- Eat fresh fruits, vegetables, whole grains, and lean protein.
- Ensure 7-9 hours of sleep; avoid overexertion due to fatigue.
- Light exercise (walking, yoga) is acceptable when feeling better.
- Maintain adequate hydration; use ORS if vomiting occurs.
- Avoid all unnecessary medications, especially OTC drugs and herbal medicines without medical advice.
- Regular liver function test monitoring post-discharge.
7. Key Points to Emphasize During Presentation
- The dramatically elevated transaminases (SGOT 910.6, SGPT 1668.2 - both >20x normal) are the most critical lab finding that confirms acute hepatocellular injury from Hepatitis A.
- The relative lymphocytosis on peripheral smear supports a viral rather than bacterial etiology.
- The pharmacist's intervention regarding Amoxiclav use is a strong clinical pharmacy point - antibiotics are not indicated for viral hepatitis unless secondary bacterial infection is confirmed.
- UDCA is used as a hepatoprotective agent to support bile flow and liver recovery.
- The patient was discharged on Day 4 (09/12/2025), indicating a reasonably good short-term response.
Good luck with your presentation! The most impactful moments will be when you explain the LFT findings, the viral mechanism of liver injury, and your pharmacist intervention recommendation regarding Amoxiclav.
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