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CASE PRESENTATION
33yr old male pt came with c/o abdominal distension since 7 days insidious in onset , gradually progressive and associated with pedal edema upto knee , pitting type from 7days and sob on exertion since 5 days, yellowish discolouration of eyes from 5days
C/o fever since 10days on and off,relieved with medication,low grade, not associated with chills and rigor
No H/O cold, cough, burning micturation, decreased output, chest pain , palpitation, giddiness, Malena, hemetemesis, vomiting,
Alcoholic from 15yrs daily 90ml stopped one month ago
Smoker beedi 10 per day
Past history:
Not a k/c/o DM , HTN,
H/o jaundice 4yrs back used medication (unknown)
Personal history:
Appetite normal
Sleep adequate
Bowel movements regular
O/E
Pt is conscious, coherent, cooperative moderately built and moderately nourished
Pallor Present
No cyanosis, clubbing, lymphadenopathy,
Pedal edema present , pitting type
Hypo pigmented patches present over neck and upper region of chest diagnosed as pytriasis versicolor
Wood lamp examination:
Vitals:
Pt is afebrile
Bp: 140/90 mmHg
Pulse: 78bpm
RR: 18cpm
CVS: S1 S2 heard
RS: Absent breath sounds in rt IAA area
CNs: NAD
Per abdomen distended
Investigations:
Diagnosis:
1. Chronic alcoholic liver disease with portal hypertension
2. Right pleural effusion
3. Normocytic normochromic anemia
4. Pityriasis versicolor
5. Hypokalemia resolving
Treatment:
1.INJ. CEFOTAXIM 2gm IV/BD
2. FLUID RESTRICTION < 1.5 Lt/day
3. 2-3 egg whites/ day
4. INJ. THIAMINE 1AMP IN 100ML NS/IV/BD
5. TAB. ALDACTONE 25 mg/PO/OD
6. TAB. PROPRANALOL 10mg/PO/OD
7. SYP. POTCHLOR 10ml in 1 glass water
8. T. PANTOP 40mg PO BD
9. Wt, AG measurement daily
10. INJ. OPTINEURON 1amp in 100 NS/IV/OD
11. TAB. RIFAGUT 550 mg PO BD
12. SYP. HEPAMERZ 10ml PO TID
13. CANDID TV LOTION/ WEEKLY TWICE for 2 weeks
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