A 31 YR OLD FEMALE PT.WITH B/L PEDAL EDEMA


Case History and Clinical Findings
Patient came to casualty with complaints of1.abdominal distention since 10days2.B/L pedal oedema
since(below knee) since 10days3.SOB on exertion since 10 days4.generalised weakness since 10
days5.decreased urine output since 10 days6.constipation since 10 daysPatient is apparently
asymptomatic 4months ago and she developed fever which is insidious in onset,low grade,
intermittent,no diurnal variation not associated with chills and rigor.Vomiting insidious in onset,non
projectile, non bilious, less quantity,odorless,non blood stained,content is food.Then she noticed
yellowish discoloration of eyes, initially noticed in eye with high coloured urine and loss of
appetite.Not associated with pruritis,clay coloured stool.For which she took herbal treatment for 1
week,after which there is no improvement .Then she went to local hospital at miryalguda and tested
positive for HbSAg she took treatment for 10 days and no improvement is observedThen she went to
Gandhi hospital and took treatment 1month 10days for the similar complaints and no improvement is
observed.Then she went to a hospital at khammam took treatment only for 2 days as they could not
afford treatment they went to home.At home she didn't take any medication for 10 days.Then she
came to our hospital with the complaints ofAbdominal distension which is insidious in onset,gradually
progressive since 10 daysSwelling of both legs below the knees since 10 days which is insidious in
onset,gradually progressive. It started at ankles and extending up to the knees.History of decrease
urine output,constipation since 10 days.Shortness of breath on exertion since 10 daysgeneralised
weakness since 10 daysNo history of abdominal pain,shortness of breath.H/O HBSAG +ve since 4
monthsN/K/C/O HTN,DM,TB,ASHMA ,CAD,Epilepsydecreased apetitevitals on admission:pt
haspallor+icterus++no cyanosisno clubbingno lymphadenopathypedal oedema+malnutrition+pt is
c/c/cafebrilePR:92bpmRR:22cpmBP:90/60mmhgSPO2:97% on
RAGRBS:117mg%CVS:s1s2+RS:BAE+
 NVBSP/A:shape of abdomen-distendedFluid Thrill+,Shifting Dullness+,no palpable
massesCNS:NFNDGASTROENTEROLOGY REFERRAL:REFERRAL WAS TAKEN I/V/O CHRONIC
LIVER DISEASE FOR WHICH SHE WAS ADVISED FOR LIVER TRANSPLANTATION
Investigation
USG ABDOMEN:ON 19/11/22
1.E/O HYPERECHOIC FOCI NOTED IN DISTENDED GB - ?ADHERENT CALCULUS
IMPRESSION:GROSS ASCITIS
HEMOGRAM:
ON 19/11/22:
HB:7.6
PCV:20.1
TLC:10,700
RBC:2.31
PLT:1.5 LAKH
PT:24
INR:1.77
APTT:47 SEC
ON 20/11/22:
HB:8.2
PCV:23.0
TLC:10,800
RBC:2.47
PLT:1.60LAKH
ON 21/11/22:
HB:6.9
PCV:19.2
TLC:7,800
RBC:2.05
PLT:1.5LAKH
ON 22/11/22:
HB:7.2
PCV:20.2
TLC:11,240
RBC:2.22
PLT:1.37 LAKH
Diagnosis
CHRONIC LIVER DISEASE SECONDARY TO ?HEPATITIS B WITH GROSS ASCITES WITH
HEPATIC ENCEPHALOPATHY
Treatment Given(Enter only Generic Name)
on 19/11/22:
1.T.ALDACTONE 50MG/PO/BD
2.T.LASIX 20MG/PO/OD
3.T.RIFAGUT 550MG/PO/BD
4.T.UDILIV 300MG/PO/BD
5.SYP.LACTULOSE 30 ML/PO/STAT
6.SYP.HEPTAMERZ 15ML/PO/TID
7.FLUID RESTRICTION LESS THAN 1 LT/DAY, SALT RESTRICTION LESS THAN 2G/DAY
8.INJ.VIT-K 1AMP IN 10ML NS/IV/OD
9.PROTEIN POWDER 1-2 SPOONS IN GLASS OF MILK/PO/TID
ON 20/11/22:
1.INJ.VIT-K 1AMP IN 10ML NS/IV/OD
2.T.ALDACTONE 50MG/PO/BD
3.T.LASIX 20MG/PO/OD
4.T.RIFAGUT 550MG/PO/BD
5.T.UDILIV 300MG/PO/BD
6.SYP.LACTULOSE 30 ML/PO/STAT
7.PROTEIN POWDER 1-2 SPOONS IN GLASS OF MILK/PO/TID
8.FLUID RESTRICTION LESS THAN 1 LT/DAY
, SALT RESTRICTION LESS THAN 2G/DAY
9.3-4EGGS WHITES/DAY
10.INJ.CEFTRIAXONE 2GM/IV/BD
11.SYP.ARISTOZYME 15ML/PO/TID
ON 21/11/22:
1.INJ.VIT-K 1AMP IN 10ML NS/IV/OD
2.T.ALDACTONE 50MG/PO/BD
3.T.LASIX 20MG/PO/OD
4.T.RIFAGUT 550MG/PO/BD
5.T.UDILIV 300MG/PO/BD
6.SYP.LACTULOSE 15 ML/PO/STAT
7.PROTEIN POWDER 1-2 SPOONS IN GLASS OF MILK/PO/TID
8.FLUID RESTRICTION LESS THAN 1 LT/DAY, SALT RESTRICTION LESS THAN 2G/DAY
9.3-4EGGS WHITES/DAY
10.INJ.CEFTRIAXONE 2GM/IV/BD
11.SYP.ARISTOZYME 15ML/PO/TID
22/11/22
1.INJ.VIT-K 1AMP IN 10ML NS/IV/OD
2.T.ALDACTONE 50MG/PO/BD
3.T.LASIX 20MG/PO/OD
4.T.RIFAGUT 550MG/PO/BD
5.T.UDILIV 300MG/PO/BD
6.SYP.LACTULOSE 15 ML/PO/STAT
7.PROTEIN POWDER 1-2 SPOONS IN GLASS OF MILK/PO/TID
8.FLUID RESTRICTION LESS THAN 1 LT/DAY, SALT RESTRICTION LESS THAN 2G/DAY
9.3-4EGGS WHITES/DAY
10.INJ.CEFTRIAXONE 2GM/IV/BD
11.SYP.ARISTOZYME 15ML/PO/TID
12.IV.FLUIDS 1 DNS SLOW WITH INJ.THIAMINE 1 AMPULE
23/11/22:1.INJ.VIT-K 1AMP IN 10ML NS/IV/OD
2.T.ALDACTONE 50MG/PO/BD
3.T.LASIX 20MG/PO/OD
4.T.RIFAGUT 550MG/PO/BD
5.T.UDILIV 300MG/PO/BD
6.SYP.LACTULOSE 15 ML/PO/STAT
7.PROTEIN POWDER 1-2 SPOONS IN GLASS OF MILK/PO/TID
8.FLUID RESTRICTION LESS THAN 1 LT/DAY, SALT RESTRICTION LESS THAN 2G/DAY
9.3-4EGGS WHITES/DAY
10.INJ.CEFTRIAXONE 2GM/IV/BD
11.SYP.ARISTOZYME 15ML/PO/TID

12.IV.FLUIDS 1 DNS SLOW WITH INJ.THIAMINE 1 AMPULE
Advice at Discharge
1.T.TAXIM 200MG PO/BD FOR 5 DAYS2.T.ALDACTONE 50MG/PO/BD
3.T.LASIX 20MG/PO/OD
4.T.RIFAGUT 550MG/PO/BD
5.T.UDILIV 300MG/PO/BD
6.SYP.LACTULOSE 15 ML/PO/BD
7.PROTEIN POWDER 1-2 SPOONS IN GLASS OF MILK/PO/TID
8.FLUID RESTRICTION LESS THAN 1 LT/DAY, SALT RESTRICTION LESS THAN 2G/DAY
9.3-4EGGS WHITES/DAY
10.SYP.ARISTOZYME 15ML/PO/TID
11.T.TAF 25MG PO/OD
Follow Up
REVIEW AT GENERAL MEDICINE OPD AFTER 15 DAYS WITH LIVER FUNCTION TESTS
REVIEW SOS
When to Obtain Urgent Care
IN CASE OF ANY EMERGENCY IMMEDIATELY CONTACT YOUR CONSULTANT DOCTOR OR
ATTEND EMERGENCY DEPARTMENT.

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