An intriguing case of ASCITES
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Date of admission : 22 November 2021
A 23 year old female who is home maker came to the OPD with the chief complaint of distension of abdomen
History of present illness :
Normal routine of the patient :
The patient wakes up by 6 AM daily, carries out all the household work, will not have breakfast, goes to the field by 10 AM and does farming, then she used to have his lunch by 1/2 PM (rice & curry or roti) and return home by 6/6.30 in the evening. Then she used to have his dinner (rice again) and sleep by 10 PM.
The patient was apparently asymptomatic 52 days back then she first felt distension of her abdomen that was gradual in nature.
She experienced diarrhea for around one month, she passed the stools as soon as she ate, the stools were not like rice water, no presence of blood.
She then developed fever associated with chills which was continuous for which she visited a local hospital. The doctor suspected typhoid and widal test was done.
She started taking medications for fever when she developed shortness of breath that was seen on lying down or sitting or walking for a short distance.
History of past illness :
The patient is not a known case of diabetes, epilepsy, tuberculosis, asthma, hypertension
Personal history :
- The patient has loss of appetite
- She takes mixed diet
- No sleep disturbances
- She has no addictions
Family history :
- There are no similar complaints in the family members
Treatment history :
- The patient has taken medications for fever
- She is not a known case of drug allergy.
General examination :
- Patient is conscious, coherent, cooperative at the time of joining
- Pallor present
- No icterus
- No cyanosis
- No clubbing of fingers and toes
- No lymphadenopathy
- Bilateral pedal edema is absent
Pulse rate - 90 bpm
Respiratory rate - 18 cycles per minute
BP - 80/50 mm Hg
23/11/21 - weight - 34 kg
Abdominal girth - 70 cm
24/11/21 - weight - 35 kg
Abdominal girth - 79 cm
25/11/21 - weight - 30 kg
Abdominal girth - 71 cm
26/11/21 - weight - 32 kg
Abdominal girth - 77 cm
Systemic examination :
CVS
Inspection - chest wall is bilaterally symmetrical
- No precordial bulge
- No visible pulsations, engorged veins, scars, sinuses
Palpation - JVP is normal
Auscultation - S1 and S2 heard
RESPIRATORY SYSTEM
- Position of trachea is central
- Bilateral air entry is normal
- Normal vesicular breath sounds heard
- No added sounds
PER ABDOMEN
- abdomen is tender
- bowel and bladder sounds heard
- free fluid is present
Inspection : shape - generalised distension due to fluid
Umbilicus -
No visible pulsations
No visible peristalsis
No striae or prominent superficial veins seen
No IVC obstruction
Palpation : shifting dullness is seen
Percussion :
Auscultation :
CNS
- Patient is conscious
- Speech is present
- Reflexes are normal
Ascitic tap was done on 22/11/21 (500 ml)
Investigations :
22/11/21 -
Ascitic fluid sugar - 44 mg/dl
Protein - 4.3 g/dl
23/11/21 -
24/11/21 -
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