A 37 years old male patient who is a resident of miryalaguda came to the opd with chief complaints of yellowish discoloration of eyes,urine since 8 days

c/o abdominal distension and fever since one week.fever was intermittent


History of present illness: 

Pt was apparently asymptomatic 7 months back,then he developed yellowish discoloration of eyes for which he was admitted to a local hospital and was diagnosed with alcoholic liver disease and was advised to stop alcohol.


2 months back his brother expired,out of agony he again started drinking alcohol 180-360 ml since 40 days.

Patient developed progressive distension of abdomen associated with yellowish discoloration of eyes and urine.

Pedal oedema since 10days.

History of  fever since 1 week


H/o constipation since 2 days


No h/o melena,hematemesis,no sleep disturbances



Past History :

Not a k/c/o Diabetes mellitus,Hypertension,

Asthma, CAD.



Treatment History 

No known drug allergies



Family History

No significant family history



Personal History :

Married

Diet is mixed

Appetite is decreased

Sleep is adequate

Bowel and bladder movements : Irregular


Addictions-

Alcoholic : whisky 180-360 ml daily



General examination-

Patient is conscious ,coherent,co operative.

Moderately built,moderately nourished .

Well oriented to time,place ,person.

Pallor absent

Ictreus-present


Clubbing absent

Cyanosis absent

Lymphadenopathy absent

pedal edema-present


vitals-

Temperature : afebrile


Bp-80/50 mmhg


PR-80 bpm


RR-16 cpm


SPO2-98 at RA





Systemic examination-

CVS- s1,s2 heard, no murmurs heard



RS- bae+,nvbs heard



PA- distended,non tender,free fluid-present,bowel sounds-present

On 26/2 :

Urine output: last 14 hrs 30ml high coloured urine 




CNS- No abnormality detected.



Investigations-


X RAY 


USG


ECG



Diagnosis-

Cirrhosis secondary to alcohol with portal hypertension with hepatorenal type-2 and gross ascites.


Treatment :

P: Inj .Thiamine 1 amp in 100 ml ns / IV/BD 


     Inj . PAN 40 mg / IV / BD 


     Inj . Zofer 4 mg / IV / tid 


     Tab . Aldactone 50 mg / po/BD 


     Inj NORAD -DS to maintain bp > 65mmhg 


     Syp . Lactulose 10ml/po/BD 


      Soap water enema


      Inj . VIT K 10mg / slow IV /OD 


      Inj. Magnexforte 1.5 GM / IV /0D 


      Proctoclysis enema - twice daily


       Inj . Lasix 20 mg IV /OD




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