Liver disorder - #9782

**Outpatient Consultation – General Medicine / Patient Name:** [ Roshan] **Age/Sex:** 19 / Female **Date:** 12-04-2025 **Chronic Illnesses:** Diabetes Mellitus (Type not specified) # **Presenting Complaints:** 1. Pain in right side of abdomen 2. Severe constipation 3. Nausea and occasional vomiting 4. Fatigue/tiredness throughout the day 5. Elevated blood sugar levels 6. Raised liver enzymes: - SGPT (ALT): 96.8 IU/L - SGOT (AST): 58 IU/L # **Provisional Diagnosis:** - **Fatty Liver (NAFLD)** – suggested by elevated SGPT/SGOT, common in diabetics - **Diabetic Gastroparesis** – causing bloating, nausea, and constipation - **Functional Constipation / Possible IBS-C** - **Hyperglycemia-induced fatigue and abdominal discomfort** ### **Suggested Investigations:** 1. Liver Function Test (LFT – repeat with GGT, ALP, Bilirubin) 2. HbA1c (to assess sugar control over 3 months) 3. Fasting and Postprandial Blood Sugar 4. Abdominal Ultrasound (for fatty liver, gallbladder, pancreas) 5. Thyroid Profile (T3, T4, TSH – hypothyroidism can worsen constipation) 6. Serum Electrolytes (to rule out imbalances causing fatigue) ### **Treatment & Management:** **1. For Constipation:** - Tab. *Lactulose* 10–15 mL at bedtime for 5–7 days - Tab. *Isabgol husk* (2 tsp) with warm water after dinner - Drink 8–10 glasses of water daily - Include fiber-rich foods: oats, papaya, soaked chia seeds, green leafy veggies - Walk for 15–20 minutes after meals **2. For Nausea/Vomiting:** - Tab. *Ondansetron 4 mg* SOS (as needed) before food - Small frequent meals, avoid oily/spicy food **3. For High SGPT/SGOT (Possible Fatty Liver):** - Tab. *Udiliv 150* – 1 tab twice daily (consult physician before starting) - Avoid fatty, fried food - Avoid self-medication (painkillers like paracetamol in excess can worsen liver) **4. For Tiredness & Blood Sugar Control:** - Recheck sugar readings and medication compliance - If on insulin/oral drugs – dosage adjustment may be needed - Include light protein in diet (boiled egg, lentils, paneer) ### **Lifestyle Advice:** 1. Walk for 30 minutes daily 2. Avoid sugar, sweetened drinks, white bread, and junk food 3. Take meals on time, no meal skipping 4. Practice deep breathing or light yoga for stress and fatigue 5. Sleep 7–8 hours daily ### **When to See a Doctor Urgently:** - Severe abdominal pain - Vomiting persists more than 1–2 days - Yellow eyes/skin (jaundice signs) - Blood in stool or dark-colored stools --- ### **Follow-Up:** - Review with reports in 7–10 days - Continue lifestyle changes and hydration Dr Shayeque Reza MD 9800280276.