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
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