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NAME : REKHA S
Patient was asymptomatic before 15 days when he developed abdominal distension which
was insidious in onset , gradually progressive , started initially around the lower abdomen
and currently uniform distended abdomen with no aggravating and relieving factors
Abdominal distension was not associated with pain abdomen
He had no h/0 vomiting , constipation
no h/o breathlessness ,chest pain
No h/o orthopnea , PND
No h/o decreased urine output , facial puffiness
Patient complaints of swelling of lower limbs
Present since 12 days ,insidious in onset , gradually progressive
Initially noticed around the ankle and currently progressed till thighs
No aggravating and relieving factors
No h/o fever
No h/o pain and redness of limbs
No h/o breathlessness
No h/0 decreased urine output
no h/o fever
No h/o pain abdomen
No h/o itching , clay coloured stools , high coloured urine
No h/o vomiting blood , blood in stools
No h/o breathlessness
No h/o involuntary movements ,altered sensorium ,change in sleep pattern
No h/o decreased urine output
No h/o decreased appetite and weight loss
Past history
He had similar complaints of abdominal distension 10 months back and was treated for
the same and it reduced
he has no h/o diabetes , hypertension , tuberculosis
No h/o tattoo, piercing , blood transfusion
No h/o past surgical intervention
Drug history
A 45 year old male who is a chronic alcohol consumer presented with abdominal
distention and swelling of lower limbs with no other complications
General physical examination
Pulse : 68 /min normal in rate ,rhythm , character , volume , arteries non palpable ,no
delays present
Blood pressure : 118/80 mm of hg measured in right arm sitting position
Respiratory rate : 18 cycles / min , thoracoabdominal
Temperature : afebrile ( 98.4 F)
Head to toe examination
No alopecia
No loss of eyebrows
No xanthelasma
no parotid enlargement
No bad breath
No spider naevi
No palmar erythema , dupuytrens contracture
Nails : normal
No tremors
No gynacomastia
No loss of axillary and pubic hair
No dilated veins over abdomen
SYSTEMIC EXAMINATION
ABDOMINAL EXAMINATION :
Patient s consent was taken and examined under adequate exposure and light
Inspection :
Generalized distension of abdomen , flanks appear full
Skin is glossy
Umbilicus : everted
All quadrants move equally with respiration
No visible veins , sinuses , scars
No scratch marks
Palpation : done in supine position with both lower limbs flexed
No local rise of temperature
No tenderness
No guarding , rigidity
Liver palpable : 7 cm below the right costal margin , firm in consistency ,edges are
round ,smooth surface , non tender
Spleen : non palpable
Abdominal girth : 108 cm
xiphisternum to umbilicus : 39 cm
umbilicus to pubic symphysis : 24 cm
umbilicus to anterior superior iliac spine :
right : 38 cm
left : 38 cm
Percussion :
Liver dullness
upper border – fifth intercostal space on full expiration
lower border – dullness extends 7cm below costal margin in midclavicular line
Total liver span : 17 cm
Shifting dullness : present
Auscultation
Bowel sounds heard – 4 per minute
No venous hum
No bruit heard
A 45 year old male with a history of consumption of alcohol since 20 years presented with
abdominal distension and swelling of lower limbs suggestive of liver pathology and the
likely cause is chronic alcohol consumption and my probable diagnosis is decompensated
liver disease with ascites with no features of its complications .
Investigations
Blood profile
Liver function tests
Electrolytes
Renal function tests
Ultrasound abdomen
Hepatic elastography
Ascitic fluid examination
Management