kosthashakhaashrita kamala

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
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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

40. Vyadhi vinishchaya
Koshtashakashritha Kamala
40

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

43. DIAGNOSIS
Hepatocellular jaundice
43

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
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