Cirrhosis of liver

 

35 year old male



July 30 2023
35 year old male Patient resident of katamgur, toddy worker by occupation came with C/o distension of abdomen since 3 months
C/o shortness of breath since 3 months 
C/o pedal edema since 20 days

HOPI:
Patient was apparently asymptomatic 6months back then he developed distension of abdomen with shortness of breath grade II , insidious in onset, gradually progressive,no aggravating and relieving factors.
C/o pedal edema since 20 days,B/L pitting type extending upto the knee.
C/o fever since 7 days on and off, associated with chills and rigors.
C/o chest pain since 7 days.
C/o decreased urine output since 20days
No c/o orthopnea,PND,chest pain, palpitations.
No C/o pain abdomen, vomitings,loose stools.
Patient had similar complaints in the past (6 months back), for which he got admitted in nalgonda hospital,stayed for about 11 days and then after being relieved.patient has continued doing the work . patient had similar complaints 14 days back for which he got admitted and not being relieved came for admission.

Past history:
K/C/O CLD
K/C/O T2 DM since 6 months and is on unknown medication.
H/o albumin transfusions done.
N/K/C/O HTN, EPILEPSY, ASTHMA,TB, THYROID DISORDERS  

Personal history:
Diet:mixed
Appetite: decreased
No significant weight loss
Decreased bowel and bladder movements
Sleep disturbed
No Tobacco addiction
Alcohol consumption since 20years , daily 50ml. Alcohol consumption is being stopped by the patient 6 months back due to similar complaints then he started consuming alcohol 3 months back, about 90ml daily.

Family history:
No k/c/o HTN, EPILEPSY,ASTHMA,TB,DM, THYROID DISORDERS IN FAMILY 

Daily routine: 
before the onset of symptoms:
Patient used to wake up at 6am, went for toddy work and eat breakfast of rice and curry at 10am, at 2pm he used to have lunch and 3-7 pm he would go for toddy work,at 10pm patient used to have dinner.daily patient used to drink about 2-3times ,each time about 50ml.
After onset of symptoms:
Patient is unable to go to toddy work,sleeps daily and used to have breakfast at 10am of rice and curry and lunch at 2pm.he has a decreased appetite 

General examination:
Patient is Concious, coherent and cooperative well oriented to time place and person.
icterus present 
No cyanosis, clubbing
lymphadenopathy.
Pallor+
Pedal edema+















Temperature - 98.2F
PR- 84 bpm
BP- 120/80 mmHg
RR- 16 CPM
GRBS- 198 MG%
SYSTEMIC EXAMINATION -
CVS- S1,S2 + ,NO MURMURS 
RS- BAE+
CNS- NAD
PER ABDOMEN:
INSPECTION:
SHAPE OF ABDOMEN - DISTENDED
UMBILICUS -CENTRAL
NO SINUSES
SCARS+
Engorged veins

PALPATION: 
TENDERNESS OVER THE PERIUMBILICAL REGION
NO PALPABLE MASS
HERNIAL ORIFICES- NORMAL
FREE FLUID - YES 
LIVER -  PALPABLE
SPLEEN - NOT PALPABLE
PERCUSSION:
Fluid thrill present 
DULL NOTE ALL OVER THE ABDOMEN
AUSCULTATION:
BOWEL SOUNDS+


Diagnosis: CIRRHOTIC LIVER DISEASE ( STAGE III) T2 DM SINCE 5 MONTHS 
INVESTIGATIONS:
Heamogram:
Hb- #7.7g/dl
PCV- # 22.3 fl
TLC- 5,000 
RBC COUNT - # 2.36 millions/cumm
PLATELET COUNT - 98,000 / cumm
RBS- #194
BLOOD UREA- 14 
S.CREATININE -# 0.7
S.Na+ : #126
S.K+ :# 3.3
S Cl: #97
Prothrombin TC- 17
INR- 1.2
APTT- 35
LFT:
T.BILIRUBIN- #1.75
D.BILIRUBIN- #0.41
SGPT-11
SGOT- 27
Alkaline phosphate - #161
T.Proteins-#5.7
Albumin - 3.8
CUE:
Colour - pale yellow
RBC - nil
PUS CELLS- 3-4
SEROLOGY - NEGATIVE
TREATMENT:
1.FLUID RESTRICTION<2LIT/ DAY
2.SALT RESTRICTION<2 GM/ DAY
3.2 EGG WHITES/ DAY
4.PROTEIN POWER 2TBSP IN 1 GLASS OF WATER PO TID
5.T. SPIRONOLACTONE 25 MG PO/BD
6.STRICT INPUT/ OUTPUT CHARTING
7.BP,PR,RR, TEMPERATURE,SPO2 MONITORING 4TH HOURLY

Ascitic tap is being done on 28/7/23



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