53yr male with swelling of face

 A 53-year-old male, a Hotel owner and chief by occupation,

The patient presented to the hospital with chief complaints of

Swelling of both Legs since 10 days

Swelling of face since 7 days



HISTORY OF PRESENTING ILLNESS 

The patient was apparently asymptomatic 10 days ago.In the first week of June he had a binge of alcohol on occasion of local festival. Later he observed abdominal distension, followed by Bilateral Pedal odema which is pitting type extending up to the knee, insidious in gradually progressive , since one week .

Patient has decreased urine output since 5 days not associated with burning micturation 
  • yellowish discolouration of urine 

No c/o - Chest pain, Palpitations , Shortness of breath ,Orthopnea, PND

No c/o - Fever , Vomitings , loose stools.

PAST HISTORY


Not K/N/C- Hypertension, Epilepsy, Thyroid disorders.

PERSONAL HISTORY

Mixed diet, decreased appetite,constipation  decreased urinary frequency.
K/C/O - Chronic Alcoholic since 20 yrs , every day consumption around 360 ml 
Last consumption 1 week back.

GENERAL EXAMINATION

Patient was conscious ,non-coherent , cooperative ,well built and nourished not so well oriented to time place & person at the time of presentation.

Pallor- present

Icterus-present

Cyanosis-absent 

Clubbing-present 

Lymphadenopathy-absent

Edema -present b/l pitting type .


VITALS

Temperature-97.6'f 

Pulse rate -90bpm.

Bp-150/80mm hg 

RR-17cpm 

Spo2-99% . 

grbs-110mg/              

Abdomen examination 

INSPECTION:-

Shape of abdomen -distended 

Umbilicus-inverted.

No scars ,sinuses,straie

No visible pulsations & visible peristalsis.

Moments of all 4quadrants moving equally with respiration


Abdominal distention

      




        

    
       
                        

                          Ecchymosis on Left shoulder
     




                              Icterus present
          

                            Bilateral Pitting Oedema
          





 Percussion:-

Shifting dullness-+

No signs of fluid thrill.

CVS:-

S1,S2heard ,no murmurs.

CNS :-

Higher motor functions - intact

Cranial nerves - intact

 Sensory system - intact

Cerebellar functions are normal

Respiratory examination:- 

Trachea is central 

Chest moments -normal 

Bae-+


Investigation

09.06.2023 - 10.06.2023












11.06.2023



    

                        U.S.G impressions

ECG



Chest X-ray


12.06.2023






13.06.2023




Ascitic Fluid

Volume-3ml

Colour-clear

Rbc-nil

Tc-50

Dc-100

Others nil


ENDOSCOPY FINDINGS:

Esophagus : Grade -1 Esophageal varices (2 columns)

Stomach : Severe PHG ( portal hypertension gastropathy)

Duodenum: D1 D2 normal

Impression : Severe PHG with Grade -1 Esophageal varices 

PROVISIONAL DIAGNOSIS:

DECOMPENSATED CHRONIC LIVER DISEASE WITH PORTAL HYPERTENSION  (SPLENOMEGALY,MODERATE ASCITIS) WITH THROMBOCYTOPENIA SECONDARY TO CLD ? B12 DEFICIENCY WITH ALCOHOL WITHDRAWAL STATE.


Treatment: 

Fluid restriction <2l /day 

Injection - vitk IV/ OD ( 1Amp in 100 ml NS)

CAP-evion 400mg PO/OD

Tab- Benfothiamine 100mg PO/ TID 

Tab UDILIV 300mg PO/BD 

Tab Lorazepam 2mg 1-1-2

Tab Baclofen 20mg OD(HS)

Tab Aldactone 50mg  OD 2pm

Syrup-lactulose 15ml / PO/ BD  

Salt restriction <2l/day 

Protein rich diet (2egg white/day)


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