CLD


Welcome and greetings to every one who are visiting this blog. I am M.Anjali student of 8th sem.This is an online E log platform to discuss our patients de- indentified health data shared after taking his / her guardians informed consent.


Introduction

A 67 yr old male who have abdominal distension brought to the OPD. Patient has chief complaints of shortness of breath and raise in temperature since 10 days

HISTORY OF PRESENT ILLNESS

•H/O breathlessness of grade 2 since a month gradually progressing
Disturbed sleep
•No H/O of chest pain/ cough/ cold.
B


•He then came here and got admitted for treatment 


HISTORY OF PAST ILLNESS 

•NO H/O  previous abdominal surgeries.

Pt had breathless ness for which bought for consultation and diagnosed with HTN and DM 6 yrs back 

He is on medication 

1 t amlodipine 5 mg po/od at 8 am 

2. T glimipiride 2 mg + met formin 1000 mg po/ od at 8 am 

He is known case of CVA hemiplegia on rt side with deviation of mouth to left side 15 yrs ago 

Got treatment for 5 yrs -resolved 

H/o head injury 30 yrs ago in a train accident pt had injury at occipital region of scalp followed by altered behaviour for 6 months and used treatment for 6 months and resolved 

H/o rt knee joint pain 5 yrs back  

PERSONAL HISTORY
•Mixed diet

•Loss of appetite

•Sleep inadequate

•Bowel and Bladder movements regular
 . Alcoholic
. Tobacco 
Daily 1 beedi
Treatment history 

Blood transfusion 5 months ago 

Drug history 

T etophylline and T theophylline po/hs. Since 5 days



General examination



Pt. is conscious , coherent , cooperative

Vitals

BP 140/90 mmhg 

PR 90bpm RR 18

GRBS. 114 spo 2 95

Pallor - absent 

Icterus - absent

Cyanosis - absent 

Clubbing - present 

Lymphadenopathy : absent 

Edema : Present till knee level and of pitting type  
Bilateral pedal edema




Per ABDOMINAL examination

INSPECTION 



Abdomen is DISTENDED with flanks full

umbilicus is central slit like

Peude orange type of skin 

No scars and sinuses 

No ENGORGED veins 

No visible pulsation

PALPATION : 

all inspectory findings confirmed 

No rise of temperature and tenderness 

No guarding and rigidity 

Organomegaly not able to elicit 

Abdominal girth was127cms 

At present 125 cms at umbilicus

Weight was 100kg

PERCUSSION : 

Shifting dullness - Present 

Fluid thrills - negative 

Puddle sign cannot be elicited ,as pt is not cooperative 

:Abdominal girth 127 now 125 at umbilicus

Weight was 100kg

AUSCULTATION :

bowel sounds are heard
No bruits




CVS 

S1S2 +, no murmurs

Respiratory system

BAE + with b/l Ronchi 

CNS 

HMF intact 
No cerebellar and meningial signs 

INVESTIGATION S 
Urine culture and sensitivity 


No pus cells and polymicrobial flora grown 

Ascitic fluid cytology  

No cells seen 

Ascitic culture and sensitivity 

No acid fast bacilli 

No pus cells and organism seen 

X ray 




ECG

Ultrasound abdomen

Gall bladder edema 

Liver. Coarse echotextire with irregular surface  

So chronic liver disease 

Gross ascites 

Diagnosis

CHRONIC DECOMPENSATED LIVER DISEASE WITH HIGH SAAG LOW PROTEIN ASCITES SECONDARY 

TO ALCOHOLIC LIVER DISEASE WITH B/L LOWER LIMB EDEMA GRADE 2 WITH HYPONATREMIA AND HYPOKALEMIA 





Treatment 

1 Inj. Lasix 40mg iv/od

2 T. Aldactone 50mg po/od

3 Syp. Lactulose 15ml po/tid 

4 Inj HAI s/c acc. To grbs 

5. Tab. Amlong 5mg po/od

6. Fluid restriction < 1.5L/day

7. Salt restriction < 2 g/day 

8 Therapeutic paracentesis

Soap notes



ICU bed no 4



Sob in lying down position

Stools passed

No fever spikes



O/e 

Pt. is c/c/c 

BP 140/90 mmhg 

PR 90bpm RR 18

GRBS. 114 spo 2 95

CVS S1S2 +

RS BAE + with b/l Ronchi 

P/A distended 
Decompensated chronic liver disease(secondary to alcohol)

 with known case of diabetes and Hypertension 





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