CHIEF COMPLAINTS
Abdominal distension since 20 days
Blood in stools since 3days
Sob since 20 days
Decreased urine output since 3 days
HISTORY OF PRESENTING ILLNESS
Patient was apparently asymptomatic 20 days back when he developed abdominal distension which was insidious in onset ,gradually progressed to current state ,distension changes w position ,diffuse in type and present throughout the day.
No H/o abd pain obsipation vomiting loose stools constipation
Distension is associated with SOB since 10 days initially while squatting currently even at rest(MMRC-grade-1to grade-4) ,not associated with orthopnea ,PND. .
Swelling of lower limbs since 15 days
Insidious in onset
Pitting type ,Initially involving only the feet later progressed Upto knees
No Association with scrotal swelling
No history of chest pain ,palpitations,facial puffiness .
history of high coloured urine since 20 days associated with decreased urine output since 10 days
Not associated with burning micturation,pain ,increased frequency, urgency .
History of yellowish discolouration since 2 years
Insidious in onset ,Gradually progressive ,associated with high coloured urine
not associated with itching ,pale coloured stools .
No history of fever ,headache ,rash ,joint pains ,no history of change in sleep pattern ,confusion ,altered sensorium ,no history of blood in stools, melena ,constipation .
PAST HISTORY
History of two hospitals visits in past two years
History of generalised weakness ,abdominal distension two years back ,diagnosed to have chronic liver failure
Received rehabilitation,Abstained from consuming alcohol for 1 year
Starting consuming alcohol ,followed by an Episode of jaundice 1 year back with similar complaints of Generalised weakness ,abdominal distension
a known case of HTN since 10 years ,DM,TB,seizures ,heart diseases,thyroid abnormalities,
No history of blood transfusions,tattooing ,or chronic drug intake ,no history of recent travel
FAMILY HISTORY
No similar complaints in the family
TREATMENT HISTORY
T.Telma 80mg initially
Later was put on T.telma 40mg
T.amlong 5 mg currently
Atenolol 50 mg currently
SUGRICAL HISTORY
No history of recent surgeries
PERSONAL HISTORY
Occupation
Diet -mixed
Appetite -decreased
Sleep -adequate
Bowel and bladder -regular ,reduced output
Addictions -alcoholic since 13 years
Consumes 250-350 ml of whiskey everyday
PROVISIONAL DIAGNOSIS
this patient is acute decompensation of chronic liver disease with symptoms suggestive of portal hypertension and probably due to hepatitis secondary to alcohol .
GENERAL PHYSICAL EXAMINATION
Patient is conscious,coherent and co operative well oriented to time place and person
patient is moderately nourished and moderately built
Height -5’7
Weight -48kgs
PALLOR -absent
ICTERUS -present involving the upper bulbar conjunctiva
CYANOSIS -absent
CLUBBING -absent
LYMPHADENOPATHY -absent
PEDAL EDEMA -present
HEAD TO TOE EXAMINATION
hair is normal
No parotid swelling
Palmar erythema- present
Gynaecomastia -absent
Pale coloured nails -present
Tremors -absent
spider naevi -present
Petechae,purpurae -absent
abdominal scar -no
VITALS
TEMP - a febrile
HEART RATE -72bpm
PULSE PRSSURE -130/90mmhg
RESP RATE -16cpm
GI EXAMINATION
Abdomen examination
Inspection
Abdomen is distended in shape , with flank fullness
Umbilicus is everted
skin is normal
Spider neavi are present in upper back area
no discolouration of skin ,engorged veins ,sinuses
No visible peristalsis or pulsations
Hernial orifices Normal
PALPATION
Abdomen is non tender , with rise of temperature due to fever
No guarding no Rigidity
No organomegaly
PERCUSSION
liver
upper border of liver dullness is per used at the right 6 th inter coastal space along the mid -clavicular line on full expiration and the lower border cannot be palpated
percussion of spleen
Castell’s method - dullness is observed in 9 th ICS of any axillary line
fluid thrill -present
shifting dullness -present
AUSCULTATION
bowel sounds heard
CNS EXAMINATION
INVESTIGATIONS
DIFFERENTIAL DIAGNOSIS
viral hepatitis
Toxin induced liver damage
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