Case
wilson's disease

Age: 32 years
Sex: Male
Race: sudaness

History
History of present illness:
THE CONDITION STARTED 2 DAYS PTA WITH ABNORMAL BEHAVIOUR IN THE FORM OF IRRITABILITY, SHOUTING AND ENDED UP e\ CONFUSION TO THE DEGREE OF STUPOR AT THE DAY OF ADMISSION.THE PATIENT ALSO SUFFERED FROM INABILITY TO WALK OR SPEAK WITHIN THESE 2 DAYS AND BECAME BED_ RIDDEN.
IN THE SECOND DAY, HE WAS ADMITTED TO THIS HOSPITALíS ICU & STAYED THERE FOR 5 DAYS.
HIS CONDITION IMPROVED, & WAS SENT TO THE GENERAL WARD IN GOOD CONDITION.


Medical History:
THE PATIENT HAS HISTORY OF SEVERAL ADMISSIONS IN THIS HOSPITAL e\ THE SAME COMPLAINTS
+ve H. OF JAUNDICE & ASCITES MANY TIMES WITHIN THESE 2 YEARS
NOT KNOWN TO BE DIABETIC OR HYPERTENSIVE.
-ve H. OF BLOOD TRANSFUSION.
-ve H. OF CONTACT e\ JAUNDICED PATIENT.


Past surgical history:
no history of any operation

Allergies:
not allergic to pencilline or any other known drugs

Medications:
metronidaze tabs 500 mg TDS
dextrose 10% TDS
omepraazole 20 mg OD
vitamin K injection OD
folic acid & ferrous sulphate tabs
penicillamine tabs 500mg OD
lactulose syrupe 10 ml TDS

Family history:
there is a family history of psychatric illness in his brother & treated with psychitriest
there is no family history of similar condition
-ve FH OF JAUNDICE.
-ve FH OF DM, HTN, CARDIAC DISEASES, ASTHMA OR RENAL DISEASES.



Social history:
HE HAS 2 BROTHERS & 2 SISTERS
HIS BROTHER & HIS MOTHER NOW ARE TAKING CARE OF HIM.
HE IS COMPLETELY BED-RIDDEN.
THEY ARE OF LOW SOCIO-ECONOMIC STATUS.
THEY DONíT HAVE MEDICAL INSURANCE .
he is not alcoholic user , not smoker or sunffer


Physical Exam
General:
PATIENT LOOKS UNWELL, LYING FLAT, CONFUSED, SLIGHTLY PO , JO , NOT CO .


Temperature:
37,7 C

Heart rate:
78/MIN, REGULAR, OF NORMAL VOLUME, SYNCHRONOUS & NO RFD & PERIPHERAL PULSES ARE INTACT.

Blood pressure:
125/75

Respiratory rate:
18 /MIN

Oxygen saturation:
97%

Head, ears, eyes, nose & throat:
ON EYE EXAMINATION BY SLIT LAMP THERE WAS
KAYSER_ FLEISCHER RING
EARS , NOSE & THROAT WERE NORMAL

Neck:
JVP WAS NOT RAISED
THUROID NOT ENLARGED
NO VISIUAL PALSATION

Chest:
CHEST IS OF NORMAL CONTOUR
TRACHEA IS CENTRAL
NORMAL CHEST EXPANSION
NORMAL TACTILE VOCAL FEREMITUS
IN AUSCULTATION: NORMAL BREATHING SOUNDS (VESICULAR), NO ADDED SOUNDS & NORMAL VOCAL RESONENCE


Cardiovascular:
NORMAL INSPECTION
NORMAL HS1, HS2 NO ADDED SOUNDS OR MURMURS

Abdomen:
NORMAL ABDOMINAL CONTOURS, UMBILICUS IS INVERTED, NO SCARS, PIGMENTATION, or DILATED VEINS & HERNIAL ORIFICES ARE INTACT
SPLEEN IS NOT PALPABLE
LIVER IS SHRUNKEN e\ SPAN=6
KIDNEYS & PARA_AORTIC LNs ARE NOT PALPABLE
+ve LL OEDEMA UP TO THE KNEES


GU:
NORMAL

Rectal:
NORMAL

Neurological:
HIGHER FUNCTIONS:

THE PATIENT IS CONCUOUS e\ GCS=14 BUT IS NOT ORIENTED IN TIME & PLACE BUT ORIENTED IN PERSONS.
HE SUFFERED FROM VISUAL HALLUCINATIONS (SEES CATS).
HAS ABNORMAL BEHAVIOUR IN THE FORM OF STARING, SUDDEN SHOUTING.
BOTH RECENT & REMOTE MEMORY ARE INTACT.
SPEECH IS SLURRED.
KAYSER-FLEISCHER RING IS SEEN ON NAKED-EYE EXAM.
FUNDOSCOPY SHOWS PALE DISC.
CRANIAL NERVES EXAM:
ALL CNs ARE NORMAL.

ULs EXAMs:
NORMAL INSPECTION
TONE IS NORMAL
POWER IS GRADE IV IN ALL MUSCLE GROUPS IN BOTH ULs
REFLEXES ARE NORMAL
POOR COORDINATION
LLs EXAMs:
+ve LL OEDEMA
NO DEFORMITY OR WASTING,NO ABNORMAL POSITION, ABNORMAL MOVEMENT & -ve FASCICULATION BOTH SPONTANEOUS OR INDUCED.
HYPERTONIA
POWER(GRADE 2)
REFLEXES(HYPER REFLEXIA )


Skin:
NO SKIN RASH , NO AREA OF HYPO OR HYPEER PIGMENTATION

Laboratories:
HB 10 g/dl
TWBCS 5000
RBG 88 mg/dl
RFT : UREA 29 mg/dl , CREATININE 0,9 mg/dl , Na 137 mmol/l
LFT:T.Protein =6 g/dl , Albumin = 2 g/dl , Bilirubin = 1.6 mg/dl , Direct = 1.2 mg/dl , Indirect =0.4 mg/dl
VIRAL SCREENING FOR HBsAg, HCV, & HIV WERE NEGATIVE
K 3,6 mmol/l , Ca 7,2 mg/dl

Radiology:
ABDOMINAl USS: LIVER IS SHRUNKEN, NORMAL SPLEEN, NO ASCITES.
MRI BRAIN SHOW BASLE GANGALIA INVOLVMENT

Other:
there is no facility to do aserum copper

Problems:
wilson's disease

Plan of treatment:
continue on the medication with regular reassessment

Results of treatment:
the patient general condition improved , his mood stabilized , the jaundice decrease , the started to walk ( lower limb power grade 3)




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