Ascites secondary to Chronic liver disease

 

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Ch.Srinaini

2019

roll:-33

CHIEF COMPLAINTS

 A 39year old male came with chief complaints of            - Abdominal distention since 2 months

      - Bilateral pedal edema since 2 months

       -Decreased appetite since 2 months

       - Decreased urine output since 1 month

 

HISTORY OF PRESENTING ILLNESS

Patient was apparently alright 2months  back then he developed abdominal distention which is insidious in onset gradually progressive associated with decreased appetite since then. 

Bilateral pedal edema extending upto knee since 2 months , pitting type increased on walking and relieved with rest

Decreased urinary output since 1 month 

No h/o fever, cough, breathlessness

No h/o pruritus , blood in vomiting and stools 

29/11/23

PAST HISTORY :

No h/o DM HTN TB asthma epilepsy CVA CAD.

PERSONAL HISTORY :-

Mixed diet 

Appetite -decreased 

sleep -adequate 

Bowel and bladder regular 

Consumes alcohol  180ml

stopped consumption of alcohol from the day of admission 

Smokes beedi 1 pack per day and stopped 3 months back

Daily routine. 

Patient  wakes up at 5:00am approx and freshen ups goes to his work place by cycling and have a cup of tea then at around 9 am has his breakfast (rice and dal) then he will have his lunch at 1:00 and then comes back home around 9:00 pm and  have dinner .consumes alcohol and goes to bed at 10:00pm

Alcohol comsumption alternative days

GENERAL PHYSICAL EXAMINATION:

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

moderately built and nourished.

Pallor-absent

Icterus -absent

Cyanosis-absent

Clubbing-absent

Generalised Lymphadenopathy-absent

Edema-bilateral pedal edema ,pitting type 

VITALS:

Temperature - afebrile 

PR :- 95bpm

RR : 22cpm

BP :- 110/70mm Hg

SYSTEMIC EXAMINATION 

Per abdomen - 

Inspection-

abdominal girth -

Abdomen is distended , flanks are full, skin is stretched  ,umbilicus is everted , no visible peristalsis , equal symmetrical movements in all quadrant’s with respiration , dilated abdominal veins are seen 

Palpation - 

No local rise of temperature,  no tenderness

All inspectory findings are confirmed by palpation, no rebound tenderness, gaurding and rigidity

No tenderness , No organomegaly 

Fluid thrill present 

Percussion:

Shifting dullness present — dull note is heard from the level of umbilicus 

Auscultation:

Bowel sounds heard 

CVS : S1 and S2 heart sounds heard

CNS: NO focal neurological deficits 

RR: BAE Present, normal vesicular breath sounds heard,no adventitious sounds

shape of the chest: normal

trachea appears to be central

 

Ascitic fluid

Chest x-ray 

USG abdomen 

PHES test

Interpretation:- 

INVESTIGATIONS 

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%.

29/11/23

Ward-9

Admission date- 16-11-23

S-No fever spikes 

   no stools passed 

    increased cough in the night - leading to inadequate sleep in the night 

     

O- Patient is consious ,coherent,cooperative 

     Pallor- present

   

  Icterus,cyanosis,lymphadenopathy  

clubbing -absent , pedal edema with pitting present 

Vitals-

BP-120/60mmhg

   

PR-82bpm 

RR-16cpm

Temperature-afebrile

CVS-S1 &S2 heard,no murmurs

RS-BAE+ ,NVBS

P/A-Distended, abdominal girth - 83cm -weight-46kg

CNS-No focal neurological deficits 

A- Ascites secondary to chronic liver disease 

P- Tab Lasik 40mg 

     Syrup lactulose 15ml

     Strict alcohol abstinence 

    monitor vitals

TREATMENT :

Tab LASIX 40 mg PO BD

Syp. Lactulose 10 ml  PO HS

Strict Alcohol abstinence .