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M varshith 85


 Ascites 


his 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 is welcome.                                                                                                                     

M .varshith

Roll no 85

8th semester 

CHIEF COMPLAINTS

✓A 39year old male came with chief complaints of Abdominal distention since two months Bilateral pedal edema since two  months .

✓Decreased appetite since two months.Decreased urine output since two month



HISTORY OF PRESENTING ILLNESS

✓Patient was apparently alright 2 months back then he developed abdominal distention which is insidious in onset gradually progressive  ✓Associated with decreased appetite since then. Bilateral pedal edema extending upto knee since 2 months , pitting type increased on walking and relieved with rest 

✓Decreased urinary output since 2 month  No h/o pruritus , blood in vomiting and stools,No h/o fever, cough, breathlessness.


















PAST HISTORY :

No h/o DM HTN TB asthma epilepsy CVA CAD.

PERSONAL HISTORY :-

✓Mixed diet 

✓Bowel and bladder regular 

✓Consumes alcohol  

✓Smokes beedi 1 pack per day and stopped three months back

✓Smokes beedi 1 pack per day and stopped 3 months backleep -adequate 

✓Daily routine. Alcohol comsumption alternative days

✓GENERAL PHYSICAL EXAMINATION:Patient is conscious ,coherent and cooperative and well oriented to time, place and person.

✓moderately built and nourished.

✓Pallor-absent  ✓Icterus -absent ✓Cyanosis-absent ✓Clubbing-absent ✓Generalised Lymphadenopathy-absent ✓Edema-bilateral pedal edema ,pitting type 

VITALS:

✓Temperature - afebrile ✓PR :- 95bpm

✓RR : 22cpm ✓BP :- 110/70mm Hg

SYSTEMIC EXAMINATION 

✓Per abdomen - 

✓Inspection-

✓Abdomen is distended ,

✓ flanks are full, skin is stretched 

✓umbilicus is everted  

✓no visible peristalsis , 

✓equal symmetrical movements in all quadrant’s with respiration , no dilated abdominal veins 

✓Palpation - 

✓No local rise of temperature, no tenderness

✓All inspectory findings are confirmed by palpation, no rebound tenderness, gaurding and rigidity

✓No tenderness , No organomegaly ✓Fluid thrill present ✓Percussion:

✓Shifting dullness present — dull note is heard from the level of umbilicus 

✓Auscultation:

Bowel sounds heard 

✓CVS : S1 and S2 heart sounds heard

✓CNS: NO focal neurological deficits 

✓RR: BAE Present, normal vesicular breath sounds heard,no adventitious sounds

✓shape of the chest: normal ✓trachea appears to be central

Asctic  fluid


Investigations



















Ascitic tap - 

✓Appearance - clear , yellow coloured 

✓SAAG - 1.65 g/dl

✓Serum albumin - 2.0 g/dl

✓Asctic albumin - 0.35 g/dl

✓Ascitic fluid sugar - 104mg/dl

✓Ascitic fluid protein - 0.7 g/dl

✓Ascitic fluid amylase - 17 IU /L

✓LDH : 143 IU/L 

✓Cell count- 50 cells 

✓Lymphocytes nil

✓Neutrophils 100%.

#TREATMENT :

✓Tab LASIX 40 mg PO BD

✓Syp. Lactulose 10 ml PO HS

✓Strict Alcohol abstinence .












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