39 yr old male cab driver by occupation resident of west bengal came to opd with chief complaint of 

1.Abdominal distension since 2 months

2.Bilateral pedal edema since 2 months

3.decreased appetite since 2 months

4.decreased urine output since 1 month

HOPI:

Patient was apparently asymptomatic 2 months back then he developed abdominal distension which is insidious in onset gradually progressive associated with decreased appetite since then.In the same month he observed bilateral pedal edema upto knees which is of pitting type which increased on walking relieved with rest.after 1 month he observed decrease in urine output which is insidious in onset and gradually progressive 

No h/o fever, cough, breathlessness

Past history:

Not a k/c/o DM,Asthma,TB, Epilepsy, Thyroid disorders ,HTN,CKD,CVA,CAD

Personal history:

Diet :Mixed

Appetite : normal

Sleep: adequate 

Bowel and bladder movements: regular

Occassional Alcoholic (180ml weekly once) - stopped 1 yr back

Smokes Beedi 1pack/day --stopped 3months back

General Examination:

Patient is conscious,coherent and cooperative

Moderately built and nourished

Pallor, icterus, cyanosis , clubbing, Lymphadenopathy -absent

Bilateral pedal edema subsided

Vitals : 

PR : 76 bpm

BP : 110/80 mmHg 

RR : 20 CPM

Temperature : 98.4f

Spo2 : 98 % on RA

Abdominal girth:86cms

Weight:46kg




SYSTEMIC EXAMINATION:


Per Abdomen:

Inspection:

Shape - distended 

Flanks-full

Umbilicus - inverted

All quadrants moves equally with respiration 

No engorged veins, visible pulsations,scars,sinuses

Palpation:

All inspectory findings are confirmed 

No local rise of temperature

Abdomen is soft and non tender 

spleen and liver -not palpable 

No other palpable masses

Hernial orifice are free

Percussion:

Shifting dullness present

Fluid thrill present 

Auscultation:

Bowel sounds heard






Infra axillary region. N. N

Supra scapular region. N. N

Interscapular region. N. N.  

Infrascapular region. N. N

Auscultation:

Normal vesicular breath sounds

No added sounds

Vocal resonance is normal in all areas

CNS :

Higher motor functions - intact

Cranial nerves - intact

Motor system:

            Rt- UL. LL.           Lt- UL. LL


Bulk - normal N.           N. N 


Tone - N. N.                 N. N


Power - 5/5. 5/5.         5/5. 5/5


Reflexes:         

                       UL            LL


Biceps. 2+.  2+


Triceps. 2+. 2+


Supinator. 2+. 2+


Knee 2+. 2+


Ankle. 2+. 2+


Sensory system: intact

Co ordination is present 

Gait is normal

No Cerebellar signs 

No signs of meningeal irritation 


Investigations:







On 16/11/23









On 17/11/23


                                  On 18/11/23



On 20/11/23


On 23/11/23



Provisional diagnosis:

Chronic Liver Disease


Treatment given:

1.Syrup.LACTULOSE 15ML PO HS

2.ZECOF COUGH SYRUP (5ml---5ml---5ml)

3.STRICT ALCOHOL ABSTINENCE









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