60yr old male with ascites

60yr old male shop owner from kammareddygudem came to GEN MED OPD with chief complaint of bloating of stomach since 6 days 

Patient was admitted on 23/12/22

HOPI patient was apparently asymptomatic 1 week ago. He then developed bloating of the abdomen, it was associated with poking type of pain. the pain did not have any aggravating and decreasing factors. Pain was also observed when patient would sit up from a lying down position.
Patient complained of polyuria and polydypsia since 6days.

Negative History 
No nausea
No vomiting's
No Headache
No Anorexia
No giddiness
No burning micturition 
No constipation 
No diarrhoea 

Past History 
5 yrs ago patient was diagnosed with decompensated liver disease
3yrs ago endoscopy showed esophageal varices, as treatment elastic bands were placed to prevent further bleeding.
Diabetic since 3yrs 
4 months ago the patient went to warangal hospital with similar complaints , there he was diagnosed with ascites and an asictic tap was done, and the patient was sent home with medications that he took as per instruction. At the same time he had a blood transfusion of 4 units of blood due to anemia.

Personal history 
Vegetarian diet
Good appetite 
Bowel and Micturiton normal 
Inadequate sleep 
Addictions 
Alcohol- stopped drinking alcohol one yr ago 
Cigarette- smokes 2-3 cigarettes per day 

Family history- no similar complaints 
No significant family history 

General examination 
Patient was concious, coherent and cooperative. Well oriented to time, place and person.
Thinly built, adequately nourished
No pallor 
No icterus 
No cyanosis 
No clubbing of fingers 
No pedal edema
No generalized lymphadenopathy 

Vitals 
Temperature- 98.6 F
Pulse rate- 70beats/min 
Respiratory Rate -14 breaths/min
Blood pressure- 130/90 mm of Hg
Oxygen saturation- 97%
GRBS-

Systemic Examination
CVS-
No thrills
No murmurs
S1 and S2 sound heard

Respiratory-
Dyspnea present
No wheezing
Trachea- central
Breath sounds- vesicular

Abdomen-
Inspection
Shape- Distened abdomen
Veins- supraumbilical veins seen
Flanks- full
Umbilicus- slightly everted
No scars
Hernial Orifices- normal

Palpation
Palpation confirms inspectory findings
No tenderness
No local rise in temperature
No palpable mass
Organomegaly- can not elicit due to distension

Percussion
Dull sounds present 
Shifting dullness

Asculation
Fluid thrills present

CNS
Conscious
Speech normal
No neck stiffness
Reflexes- Present and are normal
Finger-nose test- coordinated
Knee-Heel test- coordinated

 |

Investigations

23/12/22
ECG- Normal
Ascites Tap Procedure was done at 9pm.

24/12/22
Ascites Tap Procedure was done at 6pm.

25/12/22
ECG- Normal

24/12/22
Cytology report of Ascetic fluid
Microscopy- centrifuged smear, studied shows degenerated neutrophils against necrotic eosinophilic proteinaceous background
NO atypical cells
Impression- negative for malignancy

26/12/22
Bacterial culture and sensitivity report of sputum, blood and urine was done and was found to be normal

Colour Doppler 2D Echo
Conclusion- Trivial TR/AR, NO MR, NO RWMA, NO AS/MS, sclerotic AV, good LV systolic function, diastolic dysfunction, NO PAH/PE

Treatment

1- therapeutic ascitic tap
2- tab. lasix
3-monitor vitals
4- Syrup grillictus

Discharge- patient was discharged on 26/12/22.















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