A rare presentation of chronic Budd Chiari syndrome in a 13 years old female

These days pathologies related to liver are increasing due to one or other factors. Here, we review a case of a girl with Budd Chiari syndrome (BCS), which is due to obstruction of hepatic veins, in turn causing portal hypertension. The pathology of the syndrome includes hepatic venous outflow tract obstruction due to thrombosis along the vein. This in turn leads to portal hypertension and increased pressure in the inferior vena cava (IVC). Clinically, it affects the heart, liver, esophagus, rectum, superficial skin. Early diagnosis can be done by Doppler and liver biopsy to prevent chronic complications of hepatic fibrosis and cirrhosis. The patient was a 13-year-old girl who had abdominal distension, pedal edema, discoloured and decreased urine and fever. On examining the patient, we found out stunted linear and intellectual growth as per her age, low IQ and communication deficits. On ultrasonography, a nodular liver surface with rounded edges and hypoechoic nodules within the parenchyma were seen. Biochemical investigations showed increase in liver enzymes. Also, there was free fluid in abdomen, few anechoic channels in periumbilical and perisplenic regions showing color flow on Doppler. Ascitic tap showed a high total cell count with a lymphocytic predominance. Based on history by the patient, radiological findings, Ascitic tap and biochemical investigations we have come to the conclusion that this is a case of BCS. After being admitted, we gave antibiotics, diuretic, folic acid, albumin, lactulose. Patient was discharged on propanolol as prophylaxis for portal hypertension

A hospital based retrospective study of thyroid disorders on obstetric and perinatal outcomes

Background: The study was undertaken in pregnant women to understand and analyze the obstetric and foetal outcomes of thyroid disorders.Methods: TSH estimation was used as universal screening in their first visit to our hospital. Those patients with abnormal TSH values, i.e. above 2.5 mIU/ml in first trimester and above 3 mIU/ml in second and third trimesters were evaluated for free T3, free T4 and TPO Abs. They were treated accordingly and dosage adjustments made and the tests repeated once in 4-6 weeks. They were followed throughout pregnancy and delivery.Results: Total no of pregnant women screened were 904 over a period of 1 year from 15 March 2019 to 14 March 2020, of which 115 had abnormal thyroid functions, thereby the prevalence of thyroid disorders being 12.72%. Of the 115 patients with thyroid disorders, 112 were hypothyroid and 3 were hyperthyroid. Among the 112 hypothyroid cases, 48 were known cases and 64 were new cases. The total cases of subclinical hypothyroidism were 88, prevalence being 9.73% and overt cases were 24, prevalence being 2.65%; 3 cases were overt hyperthyroid, prevalence being 0.33%. 66% of subclinical hypothyroidism were TPO positive and 34% of overt hypothyroidism were TPO positive (p<0.05). Out of 115 abnormal thyroid function patients, 92 patients delivered in our hospital. There were 15 abortions, 13 spontaneous and 2 terminations of pregnancies; 7 patients have delivered outside and 1 patient lost follow up.Conclusions: The prevalence of thyroid disorders during pregnancy was significantly more in our study, hypothyroidism being the commonest. Significant numbers of cases were newly diagnosed on universal screening. The commonest disorder was subclinical hypothyroidism. Adverse maternal and foetal outcomes were almost similar in both subclinical and overt hypothyroidism. The common adverse outcomes noted were abortions, pre-eclampsia, gestational diabetes mellitus, preterm births and increased rates of caesarean sections. The adverse outcomes were significantly more in autoimmune antibody positive patients