56 year old female with abdominal distension
56 year old female, resident of narketpally Came with the chief complaints of abdominal distention since 20 days and swelling of lower limbs since 20 days
History of presenting illness:
Patient is apparently alright 20 days ago then she developed abdominal distension which is insidious in onset gradually progressive in nature,abdominal highness is present and aggravated after having food
Patient had pedal edema till knee which is on and off and since 5 days pedal edema is continuous in nature upto knee and putting type
Patient complaints of sob when abdominal bloating is present
No c/o chest pain,pnd,orthopnea,palpitations
No c/o Fever,cough,cold,vomitings,loose stools
Patient is a k/c/o chronic liver disease
K/c/o HTN since 13 years and on Tab.Telma 40mg po/od
K/c/o DM-II since 3-4 years and on Tab.Metformin 500mg po/od
K/c/o hypothyroid since 13 years and on Tab.Thyronorm 50mcg po/od
Patient was admitted 11 months back with similar complaints and ascitic therapeutic was done
PERSONAL HISTORY:
Diet: mixed
Appetite: normal
Sleep: adequate
Bowel and bladder: regular
Addictions: beetle nut pan since 30 years
FAMILY HISTORY:
No significant history.
GENERAL EXAMINATION:
Patient is conscious, coherent, and co-operative. Well oriented to time place and person.
He is moderately built and moderately nourished.
Pallor- absent
Icterus- present
Cyanosis- absent
Clubbing- absent
No lymphadenopathy
Pedal edema present upto knee
VITALS:
Temperature- Afebrile
Blood pressure- 120/80mm hg
Pulse rate- 96bpm
Respiratory rate- 20cpm
SYSTEMIC EXAMINATION:
Per abdomen:
On inspection:
Fluid thrill: +
Umbilicus: inverted
Movements of abdominal wall with respiration
Scars present
No visible peristalsis, pulsations, sinuses, engorged veins.
On palpation:
No local rise of temperature
Inspectors findings are confirmed
Soft and non tender
No palpable masses
Liver is not palpable
Spleen is not palpable
On percussion:
Dull note heard
On auscultation:
bowels sounds heard
CVS examination:
Inspection:
No raised JVP
Trachea appears to be central
The chest wall is bilaterally symmetrical
No dilated veins, scars or sinuses are seen
Palpation:
Trachea central in position
Apex beat is felt in the fifth intercoastal space, 1cm medial to the midclavicular line
Auscultation:
S1 S2 heardNo murmurs
Respiratory examination:
Shape of chest is elliptical, bilaterally symmetrical
B/L airway entry positive
Normal vesicular breath sounds
Investigations:
2D-ECHO
MRI abdomen and pelvis:
Usg abdomen and pelvis:
Decompensated chronic liver disease ?NAFLD with k/c/o HTN and hypothyroidism since 13yrs
K/c/o DM-II since 3 yrs
HCV positive
TREATMENT GIVEN:
Fluid restriction <1L per day
salt restriction <2g/day
tab.lasilactone 20/5mg PO/OD
Syp.lactulose 10ml PO/TID
tab.telma 40mg PO/OD
tab.metformin 500mg PO/OD
tab.thyronorm 25mcg PO/OD
high Protien diet -2 egg whites/day
strict I/O charting
weight and abdominal girth monitoring
monitor vitals and inform sos
Acidic tap was done and about 600ml of fluid was removed
Pre procedure vitals:BP-100/50mmhg PR:92bpm
Post procedure:BP-120/80mmhg PR:86bpm
