kosthashakhaashrita kamala case presentation
Download as PPTX, PDF17 likes7,893 views
This clinical case discusses a 7-year-old boy presenting with jaundice. Key details include: - The patient has a history of eating mud and was diagnosed with jaundice 20 days prior. - Laboratory investigations showed elevated liver enzymes consistent with hepatocellular jaundice. - A differential diagnosis was made between hepatocellular, hemolytic and extrahepatic jaundice and hepatocellular jaundice was diagnosed. - Treatment with herbal medications and panchakarma reduced the patient's symptoms and normalized liver function tests. Further treatment with Bhoomyamalaki kalkam is proposed.
kosthashakhaashrita kamala case presentation
- 1. Welcome to the clinical discussion -Dr. Divya K S 2nd Year PG Scholar, Dept of PG Studies in Kayachikitsa, SKAMCH&RC, Bangalore. 1
- 2. Patient Data Name : Master Mohammad Abuzar Age : 7 years Sex :Male Religion :Muslim Socio-Economic status :Middle class Marital status :Unmarried Occupation : Student Education :Studying in 3rd standard 2
- 3. Date of Admission : 30/7/15 Ward :MGW Source of History :Patient, patient’s mother, grand mother Case taken on : 3/8/15 Consultant Doctor :Dr. Amarnath OP No :21057 IP No :2938/15 Address :13th cross, Hosahalli mainroad, Vijayanagar, Banglore 3
- 4. Pradhana Vedana • C/o Yellowish discoloration of eyes, urine and faeces since 20 days. • Pain in abdomen since 15 days 4
- 5. Anubandha Vedana • C/o Cough and cold since 1 day • C/o Fever once in 15-20 days since 3-4 yrs • C/o Tiredness after playing for some time since he was a toddler • C/o Loose stools at least once in a month since a toddler 5
- 6. Vedana Vrittanta Pt has a habit of eating mud since the age of 2½ yrs old. Because of this habit of the patient’s parents took him to a Allopathic doctor and was given a syrup and was told by the physician that it will subside by the intake of the syrup. After this for the next 6 months the pt didn’t take any mud. After 6 months one day the pt’s mother noticed that his eyes where swollen and when asked he told that there is burning sensation in the eyes 6
- 7. he has restarted the habit of eating mud and because of that his eyes were becoming red and swollen. He was again given medicines and was told to keep him away from mud . But still the pt used to take mud while is not under the supervision of his parents. 20 days back the pt had fever and yellowish discoloration of eyes and was taken to the doctor and after blood test and investigations was diagnosed with jaundice and was advised to take Ayurvedic treatment. The patient’s mother started noticing yellowish 7
- 8. discoloration of urine and stools. The pt was taken to a folklore practioner and was given with medicines ( details not known) and after 5 days of treatment the symptoms were only partially subsided. He came to SKAMCH and RC for further treatment. His bowel and bladder habits are regular but yellowish discoloration of urine and stools was present . 8
- 9. Poorva Vyadhi Vrittanta Nothing contributary 9
- 10. Chikitsa Vrittanta • Previous medications details not known 10
- 11. Koutumbika Vrittanta • Patient has 3 siblings and all are said to be healthy • His mother and father are healthy. • Pt 11
- 12. Vayaktika Vrittanta • Diet - Mixed, Nonveg ( once in a week) • Appetite - Reduced, improving • Sleep - Normal( 7-8 hrs/ day) • Micturation - 7-8 times per day • Bowel - twice per day yellow and blackish after starting with medicines 12
- 13. • Habits - 2 cups of milk daily • - Pt has a habit of eating food(street food) on the way to home after school. 13
- 14. General Examination • Built - moderately built • Nourishment - moderately nourished • Pallor - Absent • Icterus - Absent • Cyanosis - Absent • Clubbing - Absent • Lymphadenopathy - Absent • Edema - Absent 14
- 15. • Tongue - slightly coated • Pulse - 80 BPM • B.P - 120/80 mm of Hg • Temp - 98.6° F • Respiratory - 18 Times/min • Height - 3 ½ ft 8 inch • Weight - 17 kg 15
- 16. Systemic Examination • CVS On auscultation; S1 S2 heard, No murmurs • RS Inspection • Shape of chest - bilaterally symmetrical • Respiratory rate – 18 times/min 16
- 17. Palpation Trachea - centrally placed Auscultation Normal broncho vesicular breath sounds heard 17
- 18. • PA Inspection: • no distension • Umbilicus- inverted , centrally placed • No visible peristalsis, no scars or discoloration Palpation: • Soft • Tenderness in all quadrants of the abdomen(more in right hypochondrium) • No organomegaly 18
- 19. Percussion: • Dullness heard over right hypochondrium. • Tympanic sound heard in the remaining quadrants of the abdomen Auscultation: • Bowel sounds heard 19
- 20. TInvestigation Reports R 17/7/2015 • Blood test • Liver Function Test • Total bilirubin 8.80 mg/dl • Direct bilirubin 6.13 mg/dl • Indirect bilirubin 2.67 mg/dl • Total protein 5.8 g/dl • Serum Albumin 3.2 g/dl • Globulin 2.6g/dl • AG Ratio 1:2 • S.G.O.T 2354 U/L • S.G.P.T 2063 U/L • GAMMA GT 133.3 U/L • Alkaline phosphatase 554. 2 U/L 20
- 21. • Urine examination • Physical Examination • Color Yellow • Transparency Clear • PH 6.5 • Specific Gravity 1.030 • Chemical Examination • Protein (Albumin) Negative • Sugar Negative • Ketone bodies Negative 21
- 22. • Urobilinogen Increased • Bile Salt Positive • Bile pigment Positive Microscopic Examination • RBCs Nil /hpf • Pus cells 2-3 /hpf • Epithelial cells Nil • Casts Nil • Bacteria Nil • Crystals Nil • Others Nil 22
- 23. • BLOOD TEST REPORT ON 24/07/15 • LIVER FUNCTION TEST • Total Bilirubin 2.1 mg/ dl • Diret Bilirubin 0.4 mg • Total protein 6.8 gns/ dl • Serum Albumin 3.6 gms/dl • Globulin 3.2 gm/dl • Albumin : Globulin Ratio 1:1 • Serum G.O.T 161 I.U/ L • Serum G.P.T 132 I.U/L • Serum Alkaline Phosphatase 79 IU/L 23
- 24. • ON 30/7/15 • BLOOD REPORT • LIVER FUNCTION TEST • Total Bilirubin 1.93 mg/ dl • Direct Bilirubin 0.80 mg/dl • Indirect Bilirubin 1.03 mg/dl • Total Protein 8.2 g/ dl • Albumin 4.2 g/dl • Globulin 4.0 g/dl • AG Ratio 1:1 • S.G.O.T 82.4 U/L • S.G.P.T 102.4 U/L • GAMMA GT 47. 8 • Alkaline Phosphatase 355.0 U/L 24
- 25. • Haemoglobin 11.9 gm% • Total count (WBC) 14060 cells/ cumm • Differenial count Neutrophils 71 % Lymphocytes 23 % Monocytes 6 % • Complete Blood Count 4.85 millions/cum • PCV 38.0 % • MCV 78.4 fl • MCHC 31.3 % • RDW 21.6 % Platelet Count 5.09 lakhs/ cumm 25
- 26. • Urine Examination Report • Colour yellow • Physical Examination • Transpareny clear • PH 5.0 • Specific Gravity 1.030 • Chemical Examination • Protein (Albumin) Negative • Sugar Negative • Ketone bodies Negative • Uro bilinogen Negative • Bile salt Negative • Bile pigment Negative 26
- 27. • Microscopic Examination • RBCs Nil /hpf • Pus cells 1-2 /hpf • Epithelial cells Nil • Casts Nil • Bacteria Nil • Crystals Nil • Others Nil 27
- 28. • on 4/ 8/15 • Blood test • Total Bilirubin 1.44 mg/dl • Direct Bilirubin 0.53 mg/dl • Indirect Bilirubin 0.91 mg/dl • Urine examination • Physical examination • Color Pale yellow • Transparency Clear • PH 5.0 • Specific gravity 1.015 28
- 29. • Chemical Examination • Protein(Albumin) Negative • Sugar Negative • Ketone bodies Negative • Uro bilinogen Negative • Bile Salt Negative • Bile pigment Negative • Microscopic Examination • RBCs Nil /hpf • Pus cells 1-2 /hpf • Epithelial cells • Casts • Bacteria Nil • Crystals 29
- 30. • USG of Abdomen and pelvis done on 30/7/15 • Impression: mild hepatomegaly 30
- 31. Dashavidha pariksha • Prakruti - Vata pitta • Vikruti :- Hetu -pitta and kapha pradhana tridosha Dosha -Pitta Dushya - Rasa, rakta, mamsa Prakruti - Asukari Desha -Saadharana Kaala - varsha ritu Bala -Avara 31
- 32. • Sara - Avara • Samhanana - Madhyama • Pramana - Ht- 44 inch -Wt- 17kgs • Satmya - madhura rasa, ghritha, paya • Satva - Avara • Ahara sakthi- Abvyaharana sakthi - Avara Jarana sakthi - Avara • Vyayama sakthi - Avara • Vaya - Bala 32
- 33. SAMPRAPTHI Ojo kshaya pandu Kapha prakopaka ahara krimi kaphajajirna 33
- 34. Haridra twak, netra , mootra, purisha Dagdha of rakta and mamsa Rakta and pitta prakopa krimi 34
- 35. Samprapthi ghataka • Dosha - pitta and kapha pradhana tridosha • Dooshya - rasa, rakta, mamsa • Agni - mandha • Srothas - rasavaha , rakthavaha srothas • Srotho dushti prakara – sanga and vimarga gamana • Udbava sthana -Amashaya • Vyaktha sthana - sarvasharira • Adhishtana - yakrit • Marga -abhyanthara and bahya rogamarga • Sadhyasadhyatha - sadhya 35
- 36. Amshamsha kalpana • Vata- Rooksha , Laghu , Sheetha , Khara , sukshma , Chala • Pitta – Sneha , Teekshna ushna , laghu , • visra , sara , drava • Kapha- Snigdha , Sheetha , guru , mandha , shlakshna , mruthsna , sthira 36
- 37. Vyavachedaka nidana • Pittaja pandu • Haleemaka • Shakhashritha kamala • Koshtashakashritha kamala 37
- 38. Disease Lakshanas Inclusion Exclusion Pittja pandu Peeta mootra shakrit and netra, daha, trishna, jwara, bhinna vit, athi peethabha, Peetha moothra shakrit and netra jwara Bihinna vit, daha Trishna Haleemeka Pandu varna or haritha or shyava peetatva of twak, moothra, purisha and akshi Balotsaha kshaya, tantra, Mandagni, mrudu jwara, streeshuharsho, angamardhascha daha trishna aruchi, bhrama Agni dourbhalya, Balotsaha kshaya aruchi Pandu varna, haritha or shyava peetatva of twak mootra, purisha and akshi is absent Tantra 38
- 39. Shakhashritha kamala Haridra netra mootra twak Shwetha varcha Atopa vishtambho guruna hridayena cha, dourbhalya, alpagni, parshwaarthi, hikka shwasa, aruchi, jwara Haridra netra , twak, nakhanana, jwara, alpagni, aruchi jwara Tila pishta nibha varchas Atopa, vishtambha, hridaya gaurava Parshwaarthi Hikka shwasa Koshtashakhashri tha kamala Haridra netra , twak, nakhanana, Avipaka, daurbhalya, sadana, aruchi karshiths Haridra netra , twak, nakhanana, Avipaka, daurbhalya, sadana, aruchi karshiths 39
- 41. Differential diagnosis • Haemolytic jaundice • Hepatocellular jaundice • Extrahepatic jaundice 41
- 42. Disease Inclusion Criteria Exclusion Criteria Heamolytic jaundice Direct bilirubin high, Total bilirubin is increased S.G.O.T, S.G.P.T is increased. Aneamia not present Hepato cellular jaundice Yellowish discoloration of urine , face , fecal matter and conjuctiva. S.G.O..T, S.G.P.T is increased. Alkaline phosphatase and Gamma GT is in normal level ExtraHepatic jaundice Yellowish discoloration of urine , face and conjuntiva. Total bilirubin is increased. S.G.O..T, S.G.P.T is increased Alkaline phosphatase and Gamma GT is in normal level 42
- 44. TREATMENT GIVEN Date Treatment given Observation 30/7/15- 1/8/15 1. SyP. Nirocil 2tsp- 0 – 2tsp 2. Arogyavardhini Vati 0- 1– 1 3. Katuki choorna 4. Tab. Nirocil 1-1-1 5. Haridra dhooma pana • Pain in Abdomen •Yellowish discoloration of stool, eyes and urine 2/ 8/15- 5/8/15 C.S.T 6. Shiro pichu with Arukaladi taila •Pt c/o cough and running nose •Pain in abdomen reduced •Yellowish discoloration of stool, eyes and urine reduced Advice on discharge 1.Haritaki churna ¼ tsp- ¼ tsp- ¼ tsp 2.Tab. Laghu sudhashekara 2- 2- 2 Powde 2 tab + 1/4hareetaki churna +1/2tsp ghee 3 times before food 3. Tab. Arogyavardhini 1 tid a/f 4. Tab. Nirocil 1-1-1 5. syp. Nirocil 0- 2tsp -2tsp •Tenderness of abdomen reduced •Yellowish discoloration of eyes, urine and stool absent •Cough persisting 44
- 45. Proposed line of treatment • Bhoomyamalaki kalkam 6 gm in empty stomach in the morning with takra • Vasaguduchyadi Kashayam with madhu • Lathusuthaashekara vati 1-1-1 • Datriavaleha 1tsp – 0 – 1tsp • Mandooravataka with takra anupana ½ - ½- ½ • Vyoshadi ghritha 1tsp – 0 -1tsp 45
- 46. Thank you 46