48 years old male with abdominal distension and b/l pedal edema since 3 months

This is an online E log book to discuss our patient's de-identified health data shared after taking his/her/guardian's signed informed consent. Here we discuss our individual patient's problems through series of inputs from available global online community of experts with an aim to solve those patient's clinical problems with collective current best evidence based inputs. This E log book also reflects my patient-centered online learning portfolio and your valuable inputs on the comment box.


A 48 year old male,farmer by occupation, resident of narketpally came to casualty with c/o  b/l pedal edema since 3 months, abdominal distension since 3 months.
Patient was apparently asymptomatic 10 years ago following which his son had depression in his 10th grade due to which pt underwent depression and got addicted to alcohol.9 years back he had severe depression and committed suicide by swallowing poison and admitted in KIMS,NKP and got treated and diagonosed with DM 8 years ago.He again committed suicide by swallowing sleeping pills and was treated accordingly.5 years back he had pain abdomen following which he was diagnosed with cholelithiasis and underwent ? laparoscopic cholecystectomy.then after he had multiple admissions for pain abdomen following alcohol consumption (?4/5 admissions per year).
2 years back pt developed yellowish discoloration of sclera and urine following which he was diagnosed with chronic liver disease.
3 months back pt developed abdominal distension with pedal edema admitted in NKP,Ascitic tap was done and evaluatted accordingly and discharged.10 days after discharge he again developed Ascites and pedal edema and then went to Hyderabad where Ascitic tap was done again.
I/v/o thrombocytopenia 8 pint RDP was transfused amd 4 units of Albumin (?) Was transfused.15 days hospitalized with 10 days in between patient was discharged and readmitted.

Now pt brought to casualty with similar complaints of pedal edema,gross distension of abdomen since 20 days.

K/c/o DM since 8 years on OHA.
Not a k/c/o HTN,TB,BA,CVA,CAD, Epilepsy.

He has normal appetite, takes mixed diet, regular bowel and bladder movements.

He consumes Alcohol regularly upto ?180-250 ml per day

O/E pt is c/c/c
Temp-98.2 degrees F
PR-90bpm
RR-20 cpm
BP-130/90 mm Hg
Spo2:97% @ room air
GRBS:95 mg%
CVS:S1S2+
RS:BAE+
P/A: distended,non tender
CNS:NFD









Rapid test for covid : negative
BT - 2:30
CT - 5:00
Hb - 8.4 gm/dl
TC - 7000
PCV - 23.8
PL.C - 1.10
PT - 24
APTT - 24 sec
INR 1.77
S.Urea - 32
S.creat 0.7
Na - 142
K - 3.1
Cl - 98
Ascitic sugar - 90
Ascitic protein - 1.2
Ascitic LDH - 150
S. Albumin - 2.4
Ascitic albumin - 0.5
SAAG - 1.9
Ascitic fluid amylase - 39
RBS - 79



TREATMENT:
1)T.LASIX 40 MG PO/BD
2)T.ALDACTONE 50 MG PO/OD
3)PROTEIN X POWDER 2 SCOOPS IN 100ML MILK
4)INJ.THIAMINE 1 AMP IN 100ML NS IV/OF
5)INJ.OPTINEURON 1 AMP IN 100 ML NS IV/OD
6) DAILY BODY WEIGHT AND ABDOMINAL GIRTH MONITORING
7) STRICT I/O CHARTING
8) FLUID RESTRICTION <1.5 LITRES PER DAY
9)SALT RESTRICTION <2 GM/DAY
10) GRBS CHARTING 8TH HOURLY




Ascitic fluid tap :-

Under strict aseptic precautions with procedure and related complications explained to patient and attenders the procedure was performed.site was confirmed and cleaned.10 c.c syringe needle was placed.600 ml of ascitic fluid was extracted.Post procedure patient vitals are stable.
BP 110/80 mmhg
PR 85bpm
Spo2 98%

22/11/21

HB : 8.2 gm/dl
TC - 5,600 cells/cumm
Pl.C - 1.10 

Sr. Na: 141
Sr.K: 3.5
Sr. Cl: 98

S-NO FEVER SPIKES,C/O ABDOMINAL DISTENTION WITH INGUINO SCROTAL SWELLING,SCROTAL OEDEMA+, GENERALISED PRURITUS

O- 
O/E 
PT C/C/C
BP- 100/70MMHG
PR-88BPM
CVS-S1S2+
RS-22CPM
ABDOMINAL GIRTH-108CM
WEIGHT-82KG
P/A-DISTENDED ,NON TENDER

A-
CHRONIC LIVER DISEASE WITH GROSS ASCITIS.INGUINO SCROTAL SWEELING WITH  SCROTAL EDEMA

P-
TREATMENT:
1)T.LASIX 40 MG PO/BD
2)T.ALDACTONE 50 MG PO/OD
3)PROTEIN X POWDER 2 SCOOPS IN 100ML MILK
4)INJ.THIAMINE 1 AMP IN 100ML NS IV/OF
5)INJ.OPTINEURON 1 AMP IN 100 ML NS IV/OD
6) DAILY BODY WEIGHT AND ABDOMINAL GIRTH MONITORING
7) STRICT I/O CHARTING
8) FLUID RESTRICTION <1.5 LITRES PER DAY
9)SALT RESTRICTION <2 GM/DAY
10) GRBS CHARTING 8TH HOURLY

23/11/21

S-NO FEVER SPIKES,C/O ABDOMINAL DISTENTION WITH INGUINO SCROTAL SWELLING,SCROTAL OEDEMA+, GENERALISED PRURITUS

O- 
O/E 
PT C/C/C
BP- 110/70MMHG
PR-80BPM
CVS-S1S2+
RS-22CPM
ABDOMINAL GIRTH-118CM
WEIGHT-80KG
P/A-DISTENDED ,NON TENDER

A-
CHRONIC LIVER DISEASE WITH GROSS ASCITIS.INGUINO SCROTAL SWEELING WITH  SCROTAL EDEMA

P-
TREATMENT:
1)T.LASIX 40 MG PO/BD
2)T.ALDACTONE 50 MG PO/OD
3)PROTEIN X POWDER 2 SCOOPS IN 100ML MILK
4)INJ.THIAMINE 1 AMP IN 100ML NS IV/OF
5)INJ.OPTINEURON 1 AMP IN 100 ML NS IV/OD
6) DAILY BODY WEIGHT AND ABDOMINAL GIRTH MONITORING
7) STRICT I/O CHARTING
8) FLUID RESTRICTION <1.5 LITRES PER DAY
9)SALT RESTRICTION <2 GM/DAY
10) GRBS CHARTING 8TH HOURLY


24/11/21

S-NO FEVER SPIKES,C/O ABDOMINAL DISTENTION WITH INGUINO SCROTAL SWELLING,SCROTAL OEDEMA+, GENERALISED PRURITUS

O- 
O/E 
PT C/C/C
BP- 110/70MMHG
PR-80BPM
CVS-S1S2+
RS-22CPM
ABDOMINAL GIRTH-117CM
WEIGHT-79KG
P/A-DISTENDED ,NON TENDER

A-
CHRONIC LIVER DISEASE WITH GROSS ASCITIS.INGUINO SCROTAL SWEELING WITH  SCROTAL EDEMA

P-
TREATMENT:
1)T.LASIX 40 MG PO/BD
2)T.ALDACTONE 50 MG PO/OD
3)PROTEIN X POWDER 2 SCOOPS IN 100ML MILK
4)INJ.THIAMINE 1 AMP IN 100ML NS IV/OF
5)INJ.OPTINEURON 1 AMP IN 100 ML NS IV/OD
6) DAILY BODY WEIGHT AND ABDOMINAL GIRTH MONITORING
7) STRICT I/O CHARTING
8) FLUID RESTRICTION <1.5 LITRES PER DAY
9)SALT RESTRICTION <2 GM/DAY
10) GRBS CHARTING 8TH HOURLY

25/11/21
Total bilirubin : 5.11 mg/dl
Direct bilirubin : 1.16 mg/dl
SGOT : 54 IU/L
ALT : 19 IU/L
Alkaline Phosphate 190 /L
Total proteins - 6.2 gm/dl
Albumin 2.12 gm/dl

Sr.Na : 131 mEq/L
Sr K : 3.9 mEq/L
Sr Cl : 92 mEq/L

APTT : 40 sec
Prothrombin time 21 sec
INR : 1.5 sec




26/11/21


S-NO FEVER SPIKES,C/O ABDOMINAL DISTENTION WITH INGUINO SCROTAL SWELLING,SCROTAL OEDEMA+, GENERALISED PRURITUS

O- 
O/E 
PT C/C/C
BP- 110/70MMHG
PR-80BPM
CVS-S1S2+
RS-22CPM
ABDOMINAL GIRTH-118CM
WEIGHT-80KG
P/A-DISTENDED ,NON TENDER

A-
CHRONIC LIVER DISEASE WITH GROSS ASCITIS.INGUINO SCROTAL SWEELING WITH  SCROTAL EDEMA

P-
TREATMENT:
1)T.LASIX 80 MG PO/BD
2)T.ALDACTONE 50 MG PO/OD
3)PROTEIN X POWDER 2 SCOOPS IN 100ML MILK
4)INJ.THIAMINE 1 AMP IN 100ML NS IV/OF
5)INJ.OPTINEURON 1 AMP IN 100 ML NS IV/OD
6) DAILY BODY WEIGHT AND ABDOMINAL GIRTH MONITORING
7)TAB.CETRIZINE  PO BD
8) SYP LACTULOSE 10ML PO BD
 STRICT I/O CHARTING
9) FLUID RESTRICTION <1 LITRES PER DAY
10)SALT RESTRICTION <2 GM/DAY
11) GRBS CHARTING 8TH HOURLY


27/11/21


S-NO FEVER SPIKES,C/O ABDOMINAL DISTENTION WITH INGUINO SCROTAL SWELLING,SCROTAL OEDEMA+, GENERALISED PRURITUS

O- 
O/E 
PT C/C
BP- 120/80MMHG
PR-78BPM
CVS-S1S2+
RS-21CPM
ABDOMINAL GIRTH-118CM
WEIGHT-83KG
P/A-DISTENDED ,NON TENDER

A-
CHRONIC LIVER DISEASE WITH GROSS ASCITIS.INGUINO SCROTAL SWEELING WITH  SCROTAL EDEMA

P-
TREATMENT:
1)T.LASIX 80 MG PO/BD
2)T.ALDACTONE 50 MG PO/OD
3)PROTEIN X POWDER 2 SCOOPS IN 100ML MILK
4)INJ.THIAMINE 1 AMP IN 100ML NS IV/OF
5)INJ.OPTINEURON 1 AMP IN 100 ML NS IV/OD
6) DAILY BODY WEIGHT AND ABDOMINAL GIRTH MONITORING
7)TAB.CETRIZINE  PO BD
8) SYP LACTULOSE 10ML PO BD
 STRICT I/O CHARTING
9) FLUID RESTRICTION <1 LITRES PER DAY
10)SALT RESTRICTION <2 GM/DAY
11) GRBS CHARTING 8TH HOURLY

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This is an online E log book to discuss our patient's de-identified health data shared after taking his/her/guardian's signed informed consent. Here we discuss our individual patient's problems through series of inputs from available global online community of experts with an aim to solve those patient's clinical problems with collective current best evidence based inputs. This E log book also reflects my patient-centered online learning portfolio and your valuable inputs on the comment box. 50 years Years old male came to OPD with cheif complaints of shortness of breath since 10 days. Complaints of decreased urine output,nausea,B/L pedal edema and  constipation since 10 days. Patient was aparently asymptomatic 15 years back, then developed B/L pedal edema , shortness of breath and was brought to our hospital 1 session of HD done.Patient was diagnosed with CKD 15 years back and was treated conservatively(on and off). Now again 10 days back he came to OPD. Past History :
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