49 old male with breathlessness and abdominal distension

 DR.NAVYA(INTERN)

DR.CHETANA(INTERN)

DR.ABDUL RAHEEM (INTERN)

DR.ASHFAQ(INTERN)

DR.SRAVYA(INTERN)

DR.GNANADA(INTERN)

DR.CHARAN(PG1)

DR.VAMSI(PG1)

DR.SUSMITHA(PG2)

DR.ADITHYA (PG3)

DR.PRANEETH(PG3) 

DR.PRAVEEN NAIK (ASS.PROF)

DR.RAKESH BISWAS(HOD)

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Here is a case i have seen:

A 49 yr old male with abdominal distension and SOB on exertion, fever, yellowish discolouration of eyes since 15 days 

Associated with vomitings for 1 week and loose stools for 12 days and subsided with medication 

Patient was apparently asymptomatic 15 days Back then he developed fever , vomitings , loose stools for which he took medication @ local RMP 

No relief found for 3-4 days . Later he developed abdominal distension and SOB on exertion, mild pedal edema for which he was taken to a hospital in miryalguda where he was diagnosed with ALD WITH SEPSIS WITH AKI- hbsag + and treatment given 

Vomitings -1-2 episodes/day , bilious, non projectile associated with food particles lasting for 4 days and subsided with medication 

Shivering - present (whole body) due to alcohol withdrawal 

Fever - high grade , intermittent, associated with chills 

Loose stools 2-3 episodes/day , watery, foul smelling-subsided with medication 

From there he came to our hospital for further evaluation and treatment

No significant negative history 

H/O PAST ILLNESS-

No h/o HTN ,DM, asthma, epilepsy, cad,tb 

H/O surgery for multiple rib fracture - 4 years back

H/O blood transfusion-4 years back at the time of surgery 

Personal history -

He is a construction worker and has mixed diet 

Decreased appetite 

Regular - bowel and bladder movements 

No allergies 

And he is known alcoholic since 20years , daily -180ml

O/E

Pt is conscious, coherent, cooperative 

Icterus present

No signs of pallor ,cyanosis , clubbing, generalised lymphadenopathy, edema 

VITALS-

Bp-80/60mmhg

Pr-80bpm

Temp-98F

Spo2-98%

CVS-

S1,S2 +

RS-BAE+

P/A-inspection 

Shape of abdomen- distended, no visible scars, sinuses, engorged veins 

Palpation -

No tenderness , free fluid-present

Shifting dullness present

Liver -palpable, spleen -not palpable 

Auscultation- bowel sounds heard 

CNS-NAD

Investigations:

Diagnosis- ALD WITH AKI WITH SEPSIS  ( hbsag+)

Treatment:

DAY1 to DAY 7

Inj.Thiamine 1ampoule in 100 ml NS IV TID

INJ.OPTINEURON 1 AMPOULE IN IN 100 ML NS IV OD

INJ.PIPTAZ 2.25 GM IV TID

TAB.DOLO 650 MG TID for 3days

INJ.ZOFER 4MG IV SOS 

INJ.PAN 40 MG IV OD

BP/PR/TEMPERATURE MONITORING 4TH HOURLY

TAB.LORAZEPAM 2MG   1____X______1 FOR 2 DAYS

            AND X_____X______1 FOR 2 DAYS THEN STOP

NICOTEX GUMS 2MG PO SOS

DAY 8 TO DAY 11

TAB.CIPROFLOXACIN 500 MG BD

TAB.PANTOP 40 MG OD

TAB.BENFOMET PLUS OD

INJ.OPTINEURON ONE AMPOULE IN 100 ML NS IV OD

NICOTEX GUMS 2MG PO SOS

SYP.LACTULOSE 15ML TID

BP/TEMPERATURE/PR MONITORING 4TH HOURLY

DAY 12 TO DAY 16

TAB.PANTOP 40 MG OD

TAB.BENFOMET PLUS OD

SYP.LACTULOSE 15 ML TID

TAB.ZINCOVIT OD

NICOTEX GUMS 2GM PO SOS