1702102065 LONG CASE

 A 40 year-old man, who is a auto driver by occupation, presented to the hospital with

- Generalised swelling & swelling of hands & legs since 1 week

HISTORY OF PRESENT ILLNESS

Patient came to the casuality with pedal edema since 1week,which was Insidious in onset, gradually progressed to upper abdomen & developed anasarca associated with Shortness of breathe(SOB) (GRADE-IV),

Orthopnoea(discomfortwhen breathingwhile lying down) - present 

Dry cough - Present 

PND(paroxysmal nocturnaldyspnoea) - Absent

- H/O daily intake of alcohol since 13 yrs (daily 90- 180ml) present 

No h/o trauma, no c/o giddiness, headache, chest pain, burning micturition, pedal edema. No c/o nausea, vomiting.


PAST HISTORY

-Patient was apparently asymptomatic 2 years back, then he had pedal edema which is bilateral Pitting type, Insidious in onset, gradually progressive, upto knee region. Patient visited yasodha hospital with this complaints, used medications prescribed by them for 1 month & adviced to quit alcohol.but patient didn't quit alcohol 

Not a known case of Hypertension, Diabetes, Tuberculosis, Epilepsy, Cardiovascular Accident, Coronary artery disease.


PERSONAL HISTORY

-Appetite:Normal

Diet: mixed

Sleep: Adequate 

Bowel & Bladder movements: Regular

Addictions: He is a known alcoholic since 13 yrs (daily 90-180ml)


FAMILY HISTORY: Insignificant 


GENERAL PHYSICAL EXAMINATION:


Patient was conscious, coherent and cooperative

 moderately built and moderately nourished.

Pallor- no pallor

Icterus- no icterus

Cyanosis- no cyanosis

Clubbing- no clubbing

JVP - Elevated

Generalised lymphadenopathy- no generalised lymphadenopathy

-pedal edema: B/L pitting type upto knee

And generalised edema and edema on hands.

Per abdomen : no organomegaly seen .no tenderness , guarding / rigidity 

Bowel sounds : present.

VITALS:

Temperature- Afebrile

Pulse rate : 72 bpm

Respiratory Rate: 18 cycles per minute

Blood Pressure: 140/90mm Hg







SYSTEMIC EXAMINATION:

CARDIOVASCULAR SYSTEM:

S1 S2 heard. 
No murmurs

RESPIRATORY SYSTEM: 

Bilateral Air entry present. 

CENTRAL NERVOUS SYSTEM:

Higher motor functions intact

PER ABDOMEN EXAMINATION:

Abdomen - distended
Diffuse tenderness present 
Shifting dullness present
Bowel sounds heard


INVESTIGATIONS:

RENAL FUNCTION TEST:

Blood urea: 13mg/dl

Serum Creatinine: 1mg/dl

Na+ : 141 mEq/L

K+ : 4.3 mEq/L

Cl- : 99 mEq/L



RANDOM BLOOD SUGAR : 127 mg/dl



COMPLETE BLOOD PICTURE: 

Hemoglobin- 13.5g/dl

Total Leukocyte count - 9700/mm³

Neutrophils- 71%

Lymphocytes-19%

Eosinophils - 4%

Monocytes- 6%

Platelets- 3.20 lakhs/mm³



LIVER FUNCTION TEST:

Total bilirubin- 4.01 mg/dl

Direct bilirubin- 1.47 mg/dl

AST - 50 IU/L

ALT- 31 IU/L

AST:ALT - 1.6

ALP- 486 IU/L

Total protein- 5.8 g/dl

Albumin- 3.6 g/dl

Albumin:Globulin - 1.64



COMPLETE URINE EXAMINATION:

Albumin - nil


CHEST X-RAY:




ELECTROCARDIOGRAPHY: 

ULTRASONOGRAPHY:


2D ECHO:




FEVER CHART:

DIAGNOSIS :

CHRONIC LIVER DISEASE
RIGHT HEART FAILURE 


TREATMENT:


1. FLUID RESTRICTION LESS THAN 1.5LIT/DAY

2. SALT RESTRICTION LES THAN 2g/day

3. Inj. LASIX 40 mg IV BD

4. Tab. ALDACTONE 50mg PO OD

5. ABDOMINAL GIRTH MONITORING 

6. MONITORING VITALS 4TH HOURLY

7. MONITORING GRBS 12TH HOURLY

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