C/O ABDOMINAL DISTENSION SINCE 1WEEK C/O DECREASED APETTITE SINCE 1 WEEK C/O DECREASED URINE OUTPUT SINCE AFTERNOON
C/O ABDOMINAL DISTENSION SINCE 1WEEK
C/O DECREASED APETTITE SINCE 1 WEEK
C/O DECREASED URINE OUTPUT SINCE AFTERNOON
PT WAS APPARENTLY ALRIGHT 1MONTH BACK THEN HE DEVELOPED PAIN ABDOMEN ON AND OFF , THEN HE DEVELOPED ABDOMINAL DISTENSION , WHICH WAS INSIDIOUS IN ONSET , GRADUALLY PROGRESSIVE IN NATURE .
NO H/O FEVER , NAUSEA , VOMITING ,LOOSE STOOLOS , CONSTIPATION HE HAD LOSS OF APPETITE SINCE 1 WEEK AND DECREASE IN URINE OUTPUT SINCE AFTERNOON. NOT A K/C/O DM ,HTN , ASTHMA , TB , CAD , CVA , EPILEPSY OCCASIONAL ALCOHOL INTAKE , NO H/O SMOKING .
GENERAL EXAMINATION : PT IS C/C/C, MODERATELY BUILT AND NOURISHED
NO SIGNS OF PALLOR , ICTERUS , CYANOSIS , CLUBBING , LYMHADENOPATHY , EDEMA AFEBRILE
PR -120BPM
BP - 130/80 MMHG
RR - 20CPM
SPO2 - 98% AT ROOM AIR
GRBS - 108MG%
CVS - S1S2 HEARD , NO MURMURS
CNS-HMF INTACT . NFND
RS -BAE PRESENT , NO ADDED SOUNDS
P/A - ABDOMEN DISTENDED , UMBILICUS CENTRAL , FLANKS FULL , NO ORGANOMEGALY , SHIFTING DULLNESS PRESENT , FLUID THRILL ABSENT, BOWEL SOUNDS HEARD
PROVISIONAL Diagnosis :-
ASCITIS SECONDARY TO DECOMPENSATED LIVER DISEASE[ HIGH SAAG HIGH PROTEIN ]
SPONTANEOUS BACTERIAL PERITONITIS [ TC-1900]
HEART FAILURE WITH PRESERVED EJECTION FRACTION [58]
MULTICENTRIC HEPATOCELLULAR CARCINOMA ATYPICAL COMPLICATED HEMANGIOMA DENOVO DIABETES MELLITUS TYPE 2
Investigation
USG ABDOMEN AND PELVIS - E/O LIVER IRREGULAR , NODULAR BORDER OF LIVER WITH ALTERED ECHOTEXTURE MILD HEPATOMEGALY GROSS ASCITIS
2DECHO :
TRIVIAL TR /AR , NO MR NO RWMA , NO AS/MS , SCLEROTIC AV GOOD LV SYSTOLIC FUNVCTION
CECT ABDOMEN; IMPRESSION;
P/O
1. ATYPICAL COMPLICATED HAEMANGIOMA
2.MULTICENTRIC HEPATOCELLULAR CARCINOMA SUGGESTED FURTHER EVALUATION AND USG CORRELATION
GROSS ASCITES LEFT PLEURAL EFFUSION
DIASTOLIC DYSFUNCTION , NO PAH /PE CULTURE AND SENSITIVITY OF ASCITIC FLUID - NO GROWTH ASCITIC FLUID CYTOLOGY - NEGATIVE FOR MALIGNANCY CELL COUNT OF ASCITIC FLUID - 1950 CELLS WITH 98% NEUTROPHILS , 2% LYMPHOCYTES ASCITIC FLUID SAAG- 1.24 , PROTEINS - 2.9 , LDH - 317 , AMYLASE - 20 , ALBUMIN -1.4
Treatment Given:-
FLUID RESTRICTION LESS THAN 2LITRES PER DAY
SALT RESTRICTION LESS THAN 1.2G PERDAY
NEBULIZATION WITH IPRAVENT 6TH HRLY ,
BUDECORT 12TH HOURLY
INJ CEFOTAXIM 2GM IV/TID
INJ LASIX 40MG IV/BD
TAB ALDACTONE 50MG PO/OD
SYP LACTULOSE 30ML PO/BD
SYP ASCORYL P 15ML PO/TID
PROTEIN POWDER 2TABLESPOON IN 100ML MILK
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