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A 48 YEAR OLD MALE



UNIT 3 ADMISSION 

A 48 yr old male,came to casualty with 

CHIEF COMPLAINTS OF :

: Abdominal distention &
: Umbilical hernia with discharging pus since 1day

HISTORY OF PRESENT ILLNESS :

Patient was apparently asymptomatic 1 day back.then he developed

1.Abdominal distension extending to xiphisternum.because of increased distension & itching sensation, patient scratched umbilical hernia.for which tearing was there in hernia & discharge of ascitic fluid present.
2. Ascitic fluid leak from the umbilical sinus - 1 day

PAST HISTORY: 

Presence of similar complaints in past, for which  he got admitted on 23rd june 2021
https://shriyaayuthumedicinerollno13.blogspot.com/2021/06/chronic-alcoholic-liver-disease-with.html?m=1

Patient is a chronic alcoholic since 20 yrs

-4 yrs back, had complaints of
1.Ascites
2.Pedal edema
3.NEGATIVE HISTORY: No decreased urine output, No SOB

-2 yrs back, increased symptoms of
1.Pedal edema
2.Ascites
3.Vomiting(1 episode)
4.Associated with decreased appetite & weight
5.NEGATIVE HISTORY: No SOB
- Due to increased symptoms, patient got admitted in sunshine hospitals.
- 1 episode of ascitic tap done
- Used medications for 1 yr after ascitic tap along with alcohol drinking

-1 yr back
1.Melena (1 episode)
2.Pedal edema (both legs)
3.Leg pain
4.Ascites
5.Associated with decreased appetite
6.NEGATIVE HISTORY: No pain abdomen

- 4 months back, patient noticed 
1.Umbilical hernia
2.Increased symptoms
- 1 episode of ascitic tap done

- 2 months back( june 23rd ), had increased symptoms of
1.Ascites
2.SOB 
- 1 episode of ascitic tap done

- 1 day back, got admitted in casualty for 
1.Abdominal dimension
2.Discharge of ascitic fluid

-Patient is a known case of chronic alcoholic liver disease with portal hypertension

-Appendectomy 25 yrs back

-Not a known case of HTN,DM,Thyroid,Asthma,Epilepsy 

FAMILY HISTORY :
No significant history 

PERSONAL HISTORY :
Diet : mixed
Appetite : Normal
Sleep : inadequate 
Addiction : chronic alcoholic 
                    Toddy two bottles daily 
                    Alcohol - 90 ml per day
Last drink - 3 days back

GENERAL EXAMINATION:

Patient is conscious, coherent, cooperative. 
No pallor 
No icterus 
No clubbing, cyanosis 
No koilonychia
No lymphadenopathy
No Edema 
Tremors - +
Small lesions - +

Vitals
Temperature : afebrile
Respiratory rate : 26cpm
Blood pressure : 120/70 mmHg
Pulse :82bpm


Per Abdomen :

-Distended abdomen
-Scars present 
-Engorged veins are seen
-Umbilical hernia present 
-Fluid thrill present 
-Multiple excoriation marks - +
-Gross ascites is seen
-Abdominal girth - 98 cm
-Distance between Xiphisternum and Umbilicus - 9.5 cm
-Distance between Umbilicus and Pubictubercle - 5.5 cm

RESPIRATORY SYSTEM:
BAE+ 
NVBS 

CVS :
 S1S2 HEARD 
no thrills no murmurs

CNS:
All superficial and deep reflexes are normal

PROVISIONAL DIAGNOSIS:
Chronic liver disease with portal hypertension

INVESTIGATIONS:

RBS

BLOOD UREA


SR.CREATININE

SR.ELECTROLYTES


LFT


HEMOGRAM 

RTPCR

PT

APTT

SAAG

ASCOTIC FLUID FOR LDH

ASCITIC FLUID FOR PROTEIN SUGAR

CUE


USG ABDOMEN: 

CHEST X RAY

ECG

ASCITIC FLUID:




TREATMENT:

1.TAB PAN 40mg X PO X OD
2.TAB RIFAGUT 550mg X PO X BD
3.SYP LACTULOSE X 10ml X H/S
4.SYP HEPAMERZ X 10ml X BD
5.T.LASILACTONE/PO/OD
6.Daily abdominal girth measurement
7.Daily weight measurement
8.Strict charting

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