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M varshith 85


 Ascites 


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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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