A 50Y/M with b/l pedal edema and abdominal distension

A 50 YEAR OLD MALE TRACTOR DRIVER BY OCCUPATION PRESENTED WITH

CHIEF COMPLAINTS:

Bilateral pedal edema since 3 months .

Abdominal distension since 15 days .

Itchy lesions on left hand and around head since 6 years.


HOPI:

Patient was apparently asymptomatic 3 months ago then he developed bilateral pedal edema insidious in onset & gradually progressive in nature, pitting type and extending upto knee joint.Then patient developed abdominal distension since 15days insidious in onset and gradually progressive in nature , no history of shortness of breath,chest pain,vomitings,hematemesis,dark colored stools,pain abdomen. No history of fever , cough , burning micturation, decreased urine output.

H/O itchy lesion with hyperpigmented lesion on left hand and around head since 6 years (on & off).H/o exposure to occupational work with chemicals.

PAST HISTORY:


K/C/O HTN since 3 years on T.Telvas-H 40/12.5 PO/OD . Stopped medication 6 months ago.

Not k/c/o DM/CVD/EPILEPSY/TB/ASTHMA.

PERSONAL HISTORY:

Appetite-Normal

Diet - Mixed

Bowel and bladder - regular 

Sleep - Normal.

General examination:

Patient is conscious, coherent, cooperative, well oriented to time , place and person .

Pallor - absent

Icterus - absent 

Cyanosis - absent 

Clubbing - absent 

Lymphadenopathy- absent 

Pedal edema - pitting type extending till knee 



VITALS:
        Temp - 96.8F
         PR - 66 bpm
         RR - 18 cpm
         BP - 110/80 mm/hg 
         SPO2 - 97% at RA
         GRBS - 102 mg/dl
Systemic examination: 

PER ABDOMEN:
Inspection :
    Umbilicus is central and inverted
    All quadrants are moving equally with respiration 
    No scars , sinuses , engorged veins, visible pulsations .
    Hernial orifices are free.
Palpitation :
     Abdomen is soft and tenderness present in right hypochondrium
     No organomegaly.
Percussion :
    Tympanic note heard over the abdomen.
Auscultation:
    Bowel sounds are heard.

CARDIOVASCULAR SYSTEM:
Inspection:
       Shape of chest is elliptical.
        No raised JVP
        No visible pulsations, scars , sinuses , engorged veins.
Palpitation:
        Apex beat - felt at left 5th intercostal space
        No thrills and parasternal heaves
Auscultation :
        S1 and S2 heard. 
RESPIRATORY SYSTEM:
Inspection: 
    Shape- elliptical 
     B/L symmetrical , 
     Both sides moving equally with respiration .
     No scars, sinuses, engorged veins, pulsations 
Palpation:
    Trachea - central
     Expansion of chest is symmetrical. 
     Vocal fremitus - normal
Percussion: 
      Resonant bilaterally 
Auscultation:
      Bilateral air entry present. Normal vesicular breath sounds heard.

CENTRAL NERVOUS SYSTEM:
      Conscious,coherent and cooperative 
      Speech- normal
      No signs of meningeal irritation. 
      Cranial nerves- intact
      Sensory system- normal 
 
Motor system:
      Tone- normal
      Power- bilaterally 5/5
     Reflexes    Right    Left
     Biceps         ++         ++
     Triceps        ++         ++
     Supinator    ++       ++
     Knee            ++       ++
     Ankle           ++        ++
















DIAGNOSIS:


DECOMPENSATED LIVER DISEASE WITH PORTAL HYPERTENSION WITH ASCITES WITH HYPERTENSION SINCE 3 YEARS


TREATMENT:


1)SALT RESTRICTION <1.2gm/day

2)FLUID RESTRICTION <2lit/day

3)TAB.RIFAXIMINE 400mg PO/BD

4)TAB.LASIX 40mg PO/BD

5)TAB.SPIRONOLACTONE 25mg PO/OD

6)SYP.LACTULOSE 15ml PO/TID











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