Given a text for medical presentation and a pool of picture slides, prepare a 6-minute presentation in consideration of the requirements for clear and clean digital slides.

Case Presentation on Patient with Jaundice

For Medical Presentation Using Digital Slides

A 61-year-old female consulted a physician for jaundice.  Four months prior to consult (PTC) , patient developed epigastric pain with accompanying fever then jaundice, a month after.  One month PTC, she noted bipedal edema.  One week PTC, she developed generalized body weakness, which worsened over the course of the week, prompting her to consult the physician.

Pertinent physical examination findings showed jaundice; enlarged globular abdomen with fluid wave; palpable and firm non-tender liver, 2cm below the rib cage; splenomegaly; and bipedal edema.

 The primary clinical diagnosis was portal hypertension secondary to liver cirrhosis.  The secondary clinical diagnosis, portal hypertension secondary to a hepatic tumor.

Using pattern recognition, patient had portal hypertension because of the presence of splenomegaly, bipeal edema, and ascites in the abdomen.  As to the cause of the portal hypertension, the main consideration was a pathology in the liver as the patient manifested jaundice and had enlarged liver.   The liver pathology might be due to a liver cirrhosis or a liver tumor, most likely cancer.  In the absence of reliable clues from the signs and symptoms and history of the patients, liver cirrhosis was chosen as the primary clinical diagnosis using prevalence process as liver cirrhosis is more common than liver tumor in the community.   

A paraclinical diagnostic procedure is needed as the degree of certainty on the primary clinical diagnosis was only 80% and treatment for the two diagnostic considerations were markedly different, i.e, supportive treatment for cirrhosis and anticancer treatment, for liver malignancy.

The table below shows the comparative degrees of certainty for the differential diagnoses and their usual treatment.

In the selection of a paraclinical procedure, the following table was drawn up to facilitate problem-solving-decision-making and securing informed consent: (the objective is to elevate the degree of certainty of the clinical diagnosis to a pretreatment diagnosis level)

Among these possible paraclinical procedures, ultrasound was chosen as the initial paraclinical diagnostic procedure by the patient and her relative.  CT scan and biopsy would be considered again after the ultrasound.  

Ultrasound of the liver showed fibrotic nodules and scarring on the liver highly suggestive of cirrhosis. 

At this point, a hepatitis profile was done which showed elevated values suggestive of chronic hepatitis.

Thus, the pretreatment diagnosis was portal hypertension secondary to cirrhosis secondary to chronic hepatitis.

The patient and her relatives agreed to the following goals of treatment for the primary diagnosis: control the progress of the liver cirrhosis and control the ascites and bipedal edema.

The following tables show options and plans for treatment for the two treatment goals:

Control of the progression of liver cirrhosis:

The patient was given anti-hepatitis drugs.

She was also advised against intake of substances and foods that could aggravate her liver cirrhosis.

Control of the ascites and edema:

It was decided that diuretic drugs would be given only when necessary.

Prevention and Health Promotion:

The final diagnosis was portal hypertension secondary to liver cirrhosis secondary to chronic hepatitis.   

Patient and relatives were advised on the diagnosis and prognosis and they understood and accepted the explanations and advices on supportive care.

At the end of the day, the following general goals in the patient management were achieved: resolution of the health problem (through acceptance of the incurable disease accompanied by comfort-supportive measures) in such as a way that the patient does not end up dead; does not have unwarranted disability and complication; is satisfied; and there are no medicolegal issues.

Mission accomplished.

Gallery of pictures that may be used for the presentation (Students have to select and edit pictures as needed.  They are free to get other pictures from the NET.):

ROJ@12jun29