202308047

 

Case History and Clinical Findings

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

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 SENSTIVITY 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(Enter only Generic Name) 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

Advice at Discharge

FLUID RESTRICTION LESS THAN 2LITRES PER DAY SALT RESTRICTION LESS THAN 1.2G PERDAY

TAB TAXIM 200MG PO/BD X 5 DAYS TAB LASIX 40MG PO/BD X 5DAYS

TAB ALDACTONE 25MG PO/OD X 5DAYS SYP LACTULOSE 30ML PO/BD X 5DAYS SYP ASCORYL P 15ML PO/TID X 5DAYS

PROTEIN POWDER 2TABLESPOON IN 100ML MILK