A 36 yr old male came with chief complaint of abdominal distension
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A 36 yr old male patient who is a florist by occupation and a resident of miryalaguda
Presented to the casualty with chief complaints of. Abdominal distension since 2 months
Bilat.pedal edema since 2 months.
Scrotal swelling since 2 months
HOPI:
This patient was apparently asymptomatic 3 yrs back.then he developed abdominal distension and pedal edema for which he visited local hospital and was diagnosed as liver disease and used medication for a while and stopped after the complaints subsided .
he was diagnosed as diabetic back then and is on treatment (metformin 500 mg ).
6 months back he had similar compliants of abdominal distension and SOB.he was put on medication but he did not get any relief for it , his symptoms got aggravated then he visited other hospital with abdominal distension and SOB at rest , back then he was diagnosed as DCMP secondary to alcoholism with Chronic Liver Disease with Alcohol Dependence Syndrome with DM - 2 .
He was admitted to our hospital 11days back for similar compliants ie SOB and abdominal distension till the xiphisternum followed by pedal edema which was insidious in onset and gradually progressive till the scrotum.
Past history:
He's a known case of DM -2 since 3 years and under treatment of Tab Metformin 500 mg
HFrEF since 6 months
Chronic liver disease since 3 years
Not a known case of asthma, tuberculosis, hypertension,thyroid, epilepsy.
Personal history:
Diet - mixed
Appetite - normal
Sleep - adequate
Bowel and bladder habits - regular
Addictions : smoking since 8 years
Alcohol since 8 years
Family history :
no significant family history
GENERAL EXAMINATION:
The patient was examined in well lit room after taking his consent.
Patient is conscious ,coherent and cooperative
Patient is well oriented to time and place
Moderately built and moderately nourished
mild icterus +
Edema:
Edema of feet +
Scrotal swelling+
Abdominal distension+
No h/o pallor,clubbing,cyanosis, lymphadenopathy
Vitals :
Temp - febrile (99.2 degree Fahrenheit)
PR - 112 bpm
RR - 22 cpm
BP - 110/70 mmHg
SPO2 - 99 % at RA
GRBS - 175 mg/dl
Systemic examination :
CVS :
S1 S2 +
JVP - elevated
No parasternal heave /thrills
Apex beat - 5th ICS
RS :
BAE + , NVBS heard
P/A :
Abdomen - distended
Normal hernial orifices
Fluid thrill +
Dilated veins present
No tenderness
No palpable mass
No organomegaly
No bruit hear
CNS - no focal neurological deficit present
DIAGNOSIS:
Ascites secondary to heart failure.
Investigations :
Hemogram :
HB - 13
TLC - 12,100
N/L/E/M - 67 /20/10/3
PCV - 37.8
PLt - 3.13
RBC - 4.81
RFT :
Urea - 31
Creatinine - 0.7
Uric acid - 2.7
Calcium - 10
Phosphorous - 3.8
Sodium - 130
Potassium - 3.6
Chloride - 91
LFT :
TB - 7.26
DB -4.21
AST - 26
ALT - 17
ALP - 560
TP - 6.6
Albumin - 3.6
A/G ratio - 0.24
Ultrasound :
1.altered echotexture of liver with mild surface irregularity ?chronic liver disease
2.Raised echogenicity of B/L kidneys
3.Gall bladder wall edema
4.Gross ascites
5.Skin and subcutaneous tissue shows edematous changes in the anterior abdominal wall diffusely
ECG:
CT scan :
1.fluid restriction <1.5 l /day
2.salt restriction <2.4 g/day
3.Tab Lasix 40 mg po/bd
4.Tab Aldactone 50 mg po od
5.Tab Met xl 12.5 mg po bd
6.Tab Thiamine 100 mg po bd
7.daily weight and abdominal girth monitoring
8.I/O charting
9.Monitor vitals -4th hourly
10.Grbs - 6th hourly
11.inj HAI s/c according to sliding scale
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