37year old patient with abdominal distension and fever
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CASE PRESENTATION:
A 37 year old female patient house wife by occupation came with chief complaints of abdominal distension and fever from 5days.
HOPI:
Patient was apparently asymptomatic 5days ago then developed Abdominal distension and fever 5days back. Low grade intermittent fever not associated with chills and rigors.
H/O abdominal distension from 5days insidious onset gradually progressing.
H/O polyuria and generalised weakness
No H/O chest pain , palpitations,jaundice,melena, pedal edema , giddiness.
PAST HISTORY:
4 years ago patient had complaints of jaundice and pain abdomen for one month , usg abdomen was done which showed altered echo texture of liver , gross splenomegaly with multiple vascular channels at splenic hilum , mild ascites, right minimal pleural effusion .
She underwent splenectomy for which no records were available and the patient or her attenders were not clearly explained about the need for splenectomy.
Not a known case of HTN and DM.
PERSONAL HISTORY:
Normal appetite
Adequate sleep
Addictions:toddy drinker
Mixed diet
GENERAL EXAMINATION:
Patient is conscious coherent co-operative Oriented to time,place and person
Moderately nourished and moderately built.
VITALS:
Patient is afebrile
BP :160/100mm hg
Pulse rate : 72bpm regular
RR : 22 cpm
SYSTEMIC EXAMINATION:
Per abdomen - distended.
CVS: S1 S2 Heard no murmurs
RS: BLAE present NVBS
CNS : No abnormality detected
INVESTIGATIONS :
5/11/2020
Aptt-30secs
6/11/2020
Peripheral smear:
RBC- anipoikilocytosis with microcytes , tear drop cells , pencil forms , target cells and schistocytes.
WBC - neutrophilic leucocytosis
PLATELETS- adequate
IMPRESSION - Microcytic hypochromic anemia with neutrophilic leucocytosis
SEROLOGY - Negative
ASCITIC FLUID ANALYSIS
Serum albumin-2.8gm/dl
Ascitic albumin - 0.31gm/dl
SAAG - 2.49
LDH - 41.3IU/L
Amylase - 11.1IU/L
Sugar - 91mg/dl
Protein-0.5gm/dl
Fundoscopy - normal fundus no KF Ring seen on slit lamp examination
2D ECHO:
Mild mitral regurgitation, mild triicuspid regurgitation with PAH
Trivial aortic regurgitation
No RWMA
No AS, MS
Good LV Systolic function and no diastolic dysfunction.
USG Abdomen:
Impression- chronic liver disease
Cholelithiasis
Gross ascites
Left kidney grade 1 RPD changes.
DIAGNOSIS:
ASCITES SECONDARY TO CHRONIC LIVER DISEASE
SEVERE ANEMIA , DENOVO HYPERTENSION.
TREATMENT:
Day 1
Fluid restriction less than 1.5lit per day
Salt restriction less than 2.5gm/day
Tab lasilactone 20/50 PO OD
Tab nicardia 20mg PO STAT
Vitals,input and output monitoring
Day 2
Fluid restriction less than 1.5lit per day
Salt restriction less than 2 gm per day
Tab lasicactone 20/50 PO OD
INJ zofer 4mg IV SOS
INJ pantop 40mg IV OD
Vitals monitoring
Day 3
Fluid restriction less than 1.5lit per day
Salt restriction less than 2 gm per day
Tab lasicactone 20/50 PO OD
INJ zofer 4mg IV SOS
INJ pantop 40mg IV OD
Tab rifagute 550mg PO BD
SYP Hepamerz 10ml PO BD
Tab Cilindepine 10mg PO OD
