A 48yr old male with abdominal distension
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A 48 year old male came to OPD with chief complaints of abdominal distension from past 20days.
HOPI:-
Patient was apparently asymptomatic 20 days back then he developed abdominal distension which was insidious in onset and gradually progressed to present size and not associated with abdominal pain.
10 days back , he went to a local hospital where was given medication, but didn’t give him relief.
H/o SOB ( grade 1 to 2 ) according to mMRC since 20 days, gradually progressive from grade 1 to grade 2 . It increased on exertion and relieved on taking rest.
H/o increased frequency of stools on 15th and 16th April, hard in consistency, green in colour, 5 episodes per day, blood stained and had 5 to 6 drops of blood at the end of defecation. It is not associated with pain and relieved on medication.
H/o bilateral pedal edema since 15 days which is pitting type and extending till the knee joint.
He has decreased urine output since 10 days.
No history of burning micturition.
No H/o orthopnea , PND
No H/o fever, nausea, vomiting
No H/o chest pain, giddiness, cough.
PAST HISTORY:-
History of jaundice in the past- 2 years back and 6 months back and was managed conservatively with medication.
K/c/o Hypertension since 10 years, initially was on T.TELMA 80 mg which was later reduced to T.TELMA 40 mg and now the patient is on T.amlong 5mg and atenolol 50mg.
N/k/c/o DM-2, TB, asthma, epilepsy,CAD, CVD.
PERSONAL HISTORY:-
Mixed diet
Alcoholic since 18years
Non smoker
Regular bowel and bladder habits
Reduced appetite since 20days
FAMILY HISTORY:-
Mother is a known case of HTN,No other relevant family history
Currently he is staying with his wife, mother ,son and daughter in law
Drug history:Using Tab Telmisartan 40mg,Used tab dytor and UDCA 2years ago.
ON EXAMINATION
GENERAL Examination:
Patient is conscious, coherent and cooperative
Well oriented to time , place and person.
Moderately built and moderately nourished.
Vitals at presentation:
PR-82bpm
BP-130/80mmhg
RR-22cpm
TEMP- afebrile
No pallor, icterus ,clubbing, Cyanosis, lymphadenopathy
Pitting type of pedal edema+
Loss of muscle mass in extremities+
SYSTEMIC EXAMINATION:
1) PER ABDOMEN:
INSPECTION:
Shape of abdomen:Distended
Umbilicus:everted
Skin over the abdomen is shiny
All quadrants are moving equally with respiration
No visible peristalsis, Hernial orifices intact
Visible superficial abdominal vein running vertically down is seen
External genitalia normal
PALPATION:
Temperature:Not raised
Tenderness:Absent
No Rebound tenderness
No guarding rigidity
No hepatosplenomegaly
Abdominal girth: 104 cms
Direction of flow in left lateral abdominal vein is
downwards
Shifting dullness +
No fluid thrill
AUSCULTATION:
Bowel sounds+
No arterial bruit.
2) CARDIOVASCULAR:
Inspection: precordium normal,apex beat :5th ICS half inch medial to mid
clavicular line
Palpation:inspectory findings confirmed, No thrills or parasternal heave
Auscultation: S152+, no murmurs
3) RESPIRATORY SYSTEM:
INSPECTION:
Shape of chest:Bilaterally symmetrical, Elliptical in shape
No visible chest deformities
No kyphoscoliosis,
Abdomino thoracic respiration, No irregular respiration
No tracheal shift
No dropping of shoulders, Spino scapular distance appears equal on both sides no sinuses scars engorged veins
PALPATION
Inspectory findings confirmed by Palpation
Chest movements - normal
Chest expansion-equal on both sides
Chest circumference at the level of nipple:84cms-on inspiration:87cms
AP diameter:20cms
Transverse diameter :32cms
PERCUSSION:
Resonant note heard over all areas
AUSCULTATION:
Norma vesicular breath sounds heard
Vocal resonance: normal in all areas
4) CNS:
Higher mental functions :intact
Cranial nerves intact
Motor system:Normal power,tone,Gait
Reflexes:normal
Sensory examination:Normal
No meningeal signs
PROVISIONAL DIAGNOSIS:-
Decompensated chronic liver disease
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