55 years old male with abdominal distension

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CASE PRESENTATION:

A 55 YEAR OLD MALE CAME WITH C/O 

ABDOMINAL DISTENTION SINCE 1 MONTH

DECREASED APPETITE SINCE 20 DAYS

FEVER SINCE 10 DAYS

HOPI: 55YEAR OLD MALE RESIDENT OF NARKETPALLY MECHANIC BY OCCUPATION , CHRONIC ALCOHOLIC SINCE 30 YEARS 2 QUARTERS PER DAY AND CHRONIC SMOOKER SINCE 30 YEARS , 10 BEEDIS PER DAY HIS WIFE EXPIRED 3 YEARS AGO FROM THEN HE INCREASED THE ALCOHOL INTAKE . 

PATIENT WAS APPARENTLY ASYMPTOMATIC 1 MONTH BACK, THEN DEVELOPED ABDOMINAL DISTENTION WHICH IS INSIDIOUS IN ONSET AND GRADUALLY PROGRESSIVE. 

FEVER SINCE 10 DAYS WHICH IS OF HIGH GRADE, ASSOCIATED WITH CHILLS AND RIGORS, RAISED DURING EVENING AND NIGHT AND RELIEVED ON MEDICATION. 

HE ALSO HAD DECREASED APPETITE SINCE 20 DAYS

H/O BLACK COLOURED STOOLS FROM 10 DAYS

NO H/O PAIN ABDOMEN

NO H/O VOMITING

NO H/O LOOSE MOTIONS/CONSTIPATION

NO H/O BURNING MICTURITION

NO H/O HEMOPTYSIS

PAST HISTORY:

N/K/C/O  HTN/DM/TB/CAD/CVA/THYROID DISORDER/EPILEPSY

PERSONAL HISTORY:

DIET- MIXED

APPETITE- DECREASED

SLEEP- ADEQUATE

BOWEL AND BLADDER MOVEMENTS- REGULAR

ADDICTIONS- 

HE IS A CHRONIC ALCOHOLIC SINCE 30 YEARS( 2 QUARTERS/DAY). STOPPED SINCE 20 DAYS. 

HE IS ALSO A CHRONIC SMOKER SINCE 30 YEARS( 9 BEEDI/DAY) 

ON EXAMINATION:

PATIENT IS CONSCIOUS, COHERENT, COOPERATIVE

PALLOR- ABSENT

ICTERUS- ABSENT

CYANOSIS- ABSENT

CLUBBING- ABSENT

LYMPHADENOPATHY- ABSENT

EDEMA- ABSENT

VITALS :

AT THE TIME OF ADMISSION :

TEMP. : 97.2

PR : 88 BPM

RR : 18 CPM

BP : 100/60 MM HG

SpO2 : 98%

GRBS:108 GM/DL

WEIGHT-49. 4KGS(6/7/23)---49KGS(7/3/23) --48. 6KGS(8/3/23) ---47. 6KGS(9/3/23) ---47. 58 KGS(10/3/23) 

ABDOMINAL GIRTH- 77.8CMS(6/3/23)---77.5CMS(7/3/23)---77 CMS(8/3/23)---73CMS(9/3/23) --78. 5CMS(10/3/23) 

ON SYSTEMIC EXAMINATION:

CVS : S1, S2 HEARD

RS : BAE PRESENT

        DECREASED BREATH SOUNDS IN LEFT IAA

        

P/A : TENDERNESS PRESENT IN EPIGASTRIC AND UMBLICAL REGIONS

CNS : HMF INTACT

INVESTIGATIONS:

ON 28/2/23

ON 6/3/23

ON 7/3/23:

ASCITIC TAP IS DONE ON 6/3/23- 

ASCITIC TAP OF 450ML WAS DONE

On 8/3/23:

Plueral tap done on 8/3/23-PLUERAL TAP OF

250ML WAS DONE



ASCITIC TAP WAS FONE(8/3/23) -

ASCITIC TAP WAS DONEOF 150ML

X ray done post ascitic tap

LIGHT'S CRITERIA-

ASCITIC FLUID Add

On 9/3/34

10/3/23



MANTOUX TEST:DONE ON 8/3/23

BEFORE TEST

DAY 0

DAY1

                     DAY 2

DAY3

PROVISIONAL DIAGNOSIS:

ASCITIS UNDER EVALUATION(LOW SAAG HIGH PROTEIN ) SECONDARY TO

?CHRONIC LIVER DISEASE  TO  RULE OUT SPONTANEOUS BACTERIAL PERITONITIS 

?TB PERITONITIS 

LEFT PLUERAL EFFUSION

TREATMENT:

1) SALT RESTRICTION<2GM/DAY

2) FLUID RESTRICTION<1.2LIT/DAY

3) INJ CEFTOXIME 1GM IV/BD

4) INJ PAN 40MG  IV/BD

5) INJ LACILACTONE20/25 PO/OD@9AM

6) SYP LACTULOSE 10ML PO/BD

7) TAB DOLO 650MG PO/TID

8) STRICT INPUT /OUTPUT CHARTING