48 year old with abdominal distention.

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Here is a case I have seen: 

Unit II admission on 09/02/2021 

DR. YAMINI ( INTERN) 

DR. AMULYA ( INTERN) 

DR. SURYA PRADEEP ( INTERN) 

DR. ASHA KIRAN ( INTERN)

DR. JAYANTH ( INTERN) 

DR. VAMSHI ( INTERN)

DR. ISMAIL  (INTERN)

DR. PRADEEP ( PG 1st YEAR)

DR. NIKITHA ( PG 2nd YEAR)

DR. SUFIYA ( PG 3rd YEAR) 

DR. SATISH ( PG 3rd YEAR)

Faculty : DR. VIJAYALAXMI 

Patient C/O 

1. Abdominal distention since one year

2. B/L Pedal edema sine one month 

3. Loose stools since 3 days. 

48 year old agricultural labourer by occupation was apparently alright till 1 year back. He had insidious onset of abdominal distension, associated with black stools. 

He got admitted in Kims, narketpally and was treated for 5 days. Not associated with any hematemesis, vomitings, loose stools. He again started drinking in June ( stopped because of unavailability of alcohol). 

In October, the patient had yellowish discoloration of eyes and urine. Got admitted in private hospital for 5 days, got discharged. 

From 1 month, the patient is insidious onset of B/L Pedal edema( pitting type) along with abdominal distention. Orthopnea(-) PND(-) SOB (-) 

From one week abdominal distention and B/L Pedal edema have been increased. H/O Black stools(+) 

K/C/O DM2 and HTN since one year and on medication. Asthma(-) TB(-) epilepsy(-) CVA(-) 

H/O laparascopic cholecystectomy (5 years back) 

Patient is chronic alcoholic - 180ml/day since 20 years. Chews tobacco leaves since 20years. 

Last alcohol intake (1 week back) 

Fever(-); vomitings(-);  loose stools(-) ; pain in abdomen(-) ; chest pain(-) ; palpitations(-) constipation(-) 

VITALS: 

Pulse: 88 per minute 

BP: 120/80 mm Hg 

RR: 18 cycles per minute 

Spo2 at room air: 99%

General examination: 

Pt is C/C/C

Bilateral pedal edema present 

No signs of pallor, icterus, cyanosis, clubbing, lymphadenopathy. 

Systemic examination:

CVS : S1 S2 heard 

CNS: no focal deficit 

RS: BAE (+) vesicular breath sounds. 

Per abdomen: soft, distended 

Provisional diagnosis:

? Cirrhosis (decompensated CLD) with Gross Ascitis

Rx

1. Salt restriction <2 g/day 

2. Fluid restriction <1.5 lit/day

3. Syrup lactulose 15ml BD (stop if >2 loose stools

4. Protein powder 2tsp in 1 glass of milk 

5. Egg whites 2/day

6. Tab Rifaxamine 550mg BD for 5days

7. Tab thiamine 5mg OD 

8. Tab lalilactone BD for 5days 

9. INJ vit k 10mg OD

10. Grbs 6th hrly pre-meal