39 year old with ascites


December 07, 2023


This is a case of a 39 year old bus driver who is a resident of West Bengal.

CHIEF COMPLAINT:
Abdominal distension since 2 months.
Swelling in the leg since 2 months.
Decreased appetite since 2 months.
Decreased urine output since 1 month. 

HISTORY OF PRESENT ILLNESS-

Patient was apparently asymptomatic 2 months ago then he developed abdominal distension which was insidious in onset and gradually progressive, associated with decreased appetite. Later he developed bilateral pedal edema extending upto the knees which is of pitting type.
After a month his urine output got decreased still he continued his work as a bus driver.
His relatives started noticing that his abdomen is getting distended and his appetite is decreased.
They suggested him to see a doctor following which he took a homeopathic treatment in West Bengal But there was no improvement. He also took some ayurvedic medication but nothing seemed to work out. Then he came to our hospital with complaints of abdominal distension,pedal edema and decreased appetite.
No history of fever, breathlessness, cough 
No h/o drowsiness, loss of consciousness, palpitations, orthopnoea,pnd ,abdominal pain, fever,nausea vomiting.

PAST HISTORY:
Not a known case of diabetes mellitus, hypertension, tuberculosis, epilepsy or any other chronic illness.
No surgical history.

PERSONAL HISTORY:
 Married, 2 daughters 
Diet :mixed (consumes fish and meat)
Appetite: normal ( presently)
Sleep: disturbed 
Bowel and bladder: normal
Addiction : betel, bidi, alcohol 
Allergy: none
Hobbies: watching telivision

Daily routine:
The patient gets up early morning at 5am. After freshing up he takes water, one cup of  lemon tea with biscuits. Then he rides his cycle almost around 5km to reach his bus stand where he is working as a bus driver. By 6:30 am he starts from Siliguri.
Sometimes he takes a 72 hrs shift (West bengal to Assam).
Around 9am he stops his bus for having breakfast which mainly includes rice,dal, vegetables or fish. 
Next stop he takes around 1pm for lunch ( rice and fish). 
His assistant takes up the driving duty from there. At 10pm they finally go for dinner in a restaurant which mainly includes rice ,dal,vegetables or fish.
Later he continues driving till next day morning.

FAMILY HISTORY:

Not significant 

Clinical images:
lGeneral examination:

Patient is conscious ,coherent and cooperative and well oriented to time, place , person.

Patient was examined in a well lit room after taking their consent. 

Patient is undernourished.

Pallor- present 
Icterus -absent
Cyanosis-absent
Clubbing-absent
Generalised Lymphadenopathy-absent
Edema-bilateral pedal edema present

VITALS
Temperature : 98.3℉
PR : 90 beats per minute
BP : 100/70 mm of Hg
RR : 22 cycles per minute
SpO2 : 96% room air

Systemic examination

Per abdomen:
Inspection- 

Abdomen is distended , flanks are full, skin is stretched.
No visible peristalsis, scars, sinuses, hermial orifices.
Equal symmetrical movements in all quadrant’s with respiration.
Umbilicus: central


Palpation - 

No local rise of temperature, no tenderness
All inspectory findings are confirmed by palpation, no rebound tenderness, gaurding and rigidity.
Liver and spleen not palpable.
No organomegaly 
Fluid thrill present 

Percussion:

Shifting dullness present 

Auscultation:

Bowel sounds heard 

CVS : 
Jvp not raised 

Inspection:

Shape of chest - elliptical
No visible pulsations
No engorged veins and scars 
Apical impulse not visible


Palpation:

Apex beat present over the left 5th intercostal space 1cm medial to midclavicular line
No parasternal heave
No precordial thrill
No dilated veins

Auscultation:

S1 S2 heard ,No murmurs 

CNS: 
No focal neurological deficits
Cranial nerves,motor and sensory functions intact. 

RR: 
Upper respiratory tarct - normal
Lower respiratory tract-
Inspection:
Chest bilaterally symmetrical,
Shape- elliptical
Trachea- Midline
Palpation:
Trachea is Midline
Normal chest movements
Vocal fremitus is normal in all areas 
Normal vesicular breath sounds

No added sounds

shape of the chest: normal

Ascitic tap - 

Appearance - clear , yellow coloured 
SAAG - 1.65 g/dl
Serum albumin - 2.0 g/dl
Asctic albumin - 0.35 g/dl
Ascitic fluid sugar - 104mg/dl
Ascitic fluid protein - 0.7 g/dl
Ascitic fluid amylase - 17 IU /L
LDH : 143 IU/L 
Cell count- 50 cells 
Lymphocytes nil
Neutrophils 100%.

Provisional diagnosis:

Portal hypertension with ascites 

TREATMENT :

Tab LASIX 40 mg PO BD

Syp. Lactulose 10 ml PO HS

Strict Alcohol abstinence .

Comments

Post a Comment

Popular posts from this blog

case of hyponatremia 18/08/22

Image
A 46 year old male presented with CC of  ✓ Vomitings Since 10 days ✓ Fever since 10 days  ✓ Generalised weakness since 10 days  HOPI- Patient was apparently asymptomatic 1 year back then he had vomitings 1 to 5 episodes/day, non bilious, non projectile, non blood tinged for which he went to a govt hospital & got treated. Prior to vomitings patient had 360 ml of alcohol. Then after 2 days he had involuntary movements of both upper & lower Limbs - 1episode, which is associated with froathing, tongue bite. Patient was unconscious during this episode. He was taken to a private hospital & managed conservatively. 10 days back patient had vomitings 2-3 episodes per day, non projectile, non-bilious,  food particles as contents and not associated with pain in the abdomen. Patient had fever associated with evening rise of temperature, chills, which is intermittent and relieved on medication. Generalized weakness and Drowsiness since 10 days. Past History - Not a known cas
Read more

prefinal osce and learning points

Image
OSCE AND LEARNING POINTS PREFINAL PRACTICAL EXAMS NAME : LEKHANA ROLL NO: 64 DATE: 8 DECEMBER,2023 Blog link: 1) AUTOIMMUNE HEPATITIS: -Autoimmune hepatitis is when the body’s infection-fighting system (immune system) attacks your liver cells. -It is a long-term chronic liver disease that causes inflammation and liver damage. Experts don’t know what causes it, but it is more likely to appear in people living with other autoimmune conditions. Certain medications can also trigger autoimmune hepatitis. -It affects more women than men. -It can lead to scarring of the liver (cirrhosis) and liver failure 2)CIRRHOGENIC DOSE OF ALCOHOL: - Time to develop Alcoholic liver disease is equal to amount of alcohol consumed -Men:60-80gm /day for 10years -Women:20-40gm /day for 10 years - Alcoholic Cirrhosis,develops only in 10-20% of those who are chronically heavy drinkers. 3) VIRAL HEPATITIS LEADING TO LIVER CIRRHOSIS: - Heaptitis A has low chances of leading to long term complications like Cirrhosi
Read more