50year old male with abdominal distension,SOB,pedal edema
A50 year old male farmer by occupation came with
CHIEF COMPLAINTS:
ABDOMINAL DISTENSION Since5 Days
SHORTNESS OF BREATH Since 5 Days
B/L PEDAL EDEMA Since 5 days
HOPI:
Patient was apparently asymptomatic 5 days ago.
An asha worker during kallavelugu programme noticed and advised him to go to hospital for yellowish discoloration of eyes 5months ago.So he went to local clinic and advised to use unknown medications for 5 days ,which he used it for 3 days but it was not reduced.
Then he went to hospital at khammam and the unknown investigations were done along with endoscopy, medications were given which he used for 5 to 6 days
He used herbal medicine (aaku pasaru) for 3 days/ once a week/for 3 weeks
Later he came here with complaints of yellowish discoloration of eyes and mild abdominal distension investigations were done 4 months ago n medications given which he used for 3 months
All of a sudden the patient developed abdominal pain which was sudden in onset, gradually progressive associated with fever for that he went to khammam hospital n medications were used
He met a known doctor in a family function,showed all reports n he advised him to stop medications which were given at khammam hospital.Given him some extra unknown medications ,On that the abdominal distension got reduced as he used it for 3 days
During there thanda related festival he went out to bring some sticks for cooking purpose,there he found out that he's feeling shortness of breath and abdominal distension getting increase .So he stopped goin to feild work from then.He didnt go to any hospital but used the medications given here
On tuesday (13/6/2023) he came here with the complaints of abdominal distension which was insidious in onset ,gradually progressive which was aggravating on exertion (lifting weights) and no relieving factors
He also has shortness of breadth which is of grade -2( mmrc) since 5 days as he felt Difficulty in breathing while walking to feilds about 2kms which he used to walk everyday which at present he is feeling difficulty while walking upto 1 km , relieved on taking rest for a while .
He has pitting type(grade -1) of pedal edema bilaterally upto knees since 5 days which was insidious in onset gradually progressive and no relieving factors .
He also has yellowish discolouration of eyes.
No h/o chest pain , palpitations, pnd,orthopnea, facial puffiness
No h/o fever , chills, rigor, myalgia, rashes
No h/o Hematemesis, maleana
No h/o abdominal pain, nausea, vomiting
No h/o altered sensorium, confusion,lack of intrest in work,hair loss, excessive sweating .
PAST HISTORY:
Not a known case of DM,HTN,Asthma, Epilepsy,CVA,TB
No h/o surgeries in the past
No h/o blood transfusions
FAMILY HISTORY:
Not relevant
PERSONAL HISTORY:
DIET : MIXED (Stopped eating non veg since 5months on doctors suggestion.doctor told him to eat fish n egg but he refused to eat that too since 5 months)
APPETITE:Normal (eating less in quantity due to fear of abdominal distension)
SLEEP: Adequate
BOWEL N BLADDER : Regular
MOVEMENTS
ADDICTIONS :Had a habit of taking alcohol since 20 yrs ( gudumba 180 ml per day ) .On abstinence since 5 months on suggestion of doctor.
Not a smoker
Daily routine: Wakes up at 5 am and freshen up to go to work at 6:am as he's working as an organiser(sweeps etc) at gram panchayat(he stopped going to field work since 3 months due to above complaints).Works upto 9 am then have his breakfast and takes rest thn have his lunch and takes rest for 2 hrs and then he roams the street in the evening and then reaches home and eats his dinner at around 7 pm and then goes to bed at 7:30pm - 8:00pm .
DRUG AND ALLERGIC HISTORY:
None
GENERAL EXAMINATION:
Patient is conscious, coherent, cooperative and well oriented to time place person and moderately built and moderately nourished.
Pallor - Absent
Icterus- PRESENT
Cyanosis- Absent
Clubbing- Absent
Lymphadenopathy- Absent
Pedal edema- Present (pitting type)
HEAD TO TOE examination:
Axillary hair loss seen
No parotid swelling
Palmar erythema absent
Hyperpigmented patches seen on palm
Gynaecomastia present but non tender
Pale colour nails absent
Tremors absent
Spider naevi not seen
Duptyrene contracture - present on left hand
Petechiae, purpura not seen
No testicular atrophy
Vitals:
Temp- Afebrile
Pulse - 75 bpm
Bp - 100/80
Rr- 18 cpm
SYSTEMIC EXAMINATION:
ABDOMINAL EXAMINATION:
INSPECTION:
SHAPE: Abdomen is distended with flank fullness
SKIN OVER SURFACE : normal
No scars,engorged veins ,visible pulsations, peristalsis,discolouration over skin
Umbilicus : inverted
PALPATION :
No local rise of temperature and tenderness
No organomegaly.
Liver and spleen non palpable
Abdominal girth: 85cm(after Paracentesis)
PERCUSSION:
Upper border of liver dullness is felt at 6th ICS along mid clavicular line and lower border non felt due to distended abdomen. ?
No fluid thrill
Shifting Dullness Is Present .
AUSCULTATION:
Bowel sounds are present
RESPIRATORY EXAMINATION:
INSPECTION:
Shape elliptical
Equal movements on both side
No scars sinuses engorged veins pulsations
Trachea appears central
PALPATION:
Trachea central
B/L symmetrical chest expansion
PERCUSSION:
Resonant in all areas
AUSCULTATION: no added breath sounds
CVS EXAMINATION:
INSPECTION :
Shape of chest symmetrical
No engorged veins , no scars, no visible pulsations
JVP -normal
PALPATION:
Apex beat felt at 5 ics
No thrills and Heaves felt
AUSCULTATION:
S1 s2 heard no murmurs
CNS EXAMINATION:
Conscious coherent cooperative
Higher mental function - intact
Cranial nerves intact
Sensory - normal
Motor-
Tone normal
Power B/L 5/5
Reflexes: Right , left
Biceps ++ ++
Triceps ++ ++
Supinator ++ ++
Knee ++ ++
PROVISIONAL DIAGNOSIS:
Decompensated Chronic liver disease sec to chronic alcohol consumption.
INVESTIGATIONS :
13/6/2023:
Abdominal Paracentesis was done on 16/6/2023 - 1000ml was collected
Blood sugar
His Child pugh score is 9 and graded as Grade B with One year Survival rate at 80 and two year survival rate at 60
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