AFTER AFFECTS OF ALCOHOL USE DISORDER

 This is an online e-log book to discuss our patient's de-identified health data shared after taking his/her/guardian's informed consent. Here we discuss our individual patient's problems through series of inputs from available global online community of experts with an aim to solve those patient's clinical problems with collective current best evidence based inputs. 

Date of admission : 02 December 2021

A 36 year old male has come to OPD with chief complaints of 

1. Abdominal distension since 10 days

2. Scrotal swelling since 10 days

3. No urine output since

History of present illness : 

Daily routine of the patient :

The patient used to get up at around 7/8 in the morning, used to have breakfast and then used to go to work (he sells plants in a nursery). He used to travel to other states as well to buy the plants. He then returns home in the evening and then used to consume alcohol daily before eating which was around 400-500 ml and then sleep at around midnight at around 1/2. He used to binge watch TV until that time.

His intake of alcohol has increased to 750 ml per day (which is due to family issues according to the patient) and stopped consuming food at night.

The patient smokes 5/6 cigarettes per day and sometimes the number used to increase up to 10 also.

The patient was apparently asymptomatic 8 months back.

8 months back he started noticing his abdominal distension and scrotal swelling along with pain. At the same time he developed jaundice. He joined our hospital and took treatment for 5 days. He discontinued the medication that was prescribed for the last 10 days at that time. He also says that he has taken herbal medication for his conditions.

At that time he stopped consuming alcohol and cigarettes.

Eventually the distension and swelling subsided and the patient started smoking and drinking again.

The patient has constipation since 2 months. He is passing stools once in 3 days

10 days back, same abdominal and scrotal swelling started appearing which the patient thought it would might be because of weight gain.

As he started observing that there was no urine output, he rushed to the hospital.

History of past illness :

The patient has met with accidents once in 2011 and next in 2018 where his right side ribs were damaged and had a laceration on the right parietal bone area in the head which was sutured.

10 years ago he had a mass in the anal region - external hemorrhoids ?

He is diabetic since 2 years and is on medication.

He has no BP/asthma/TB/epilepsy

Personal history : 

- The patient has loss of appetite

- He takes mixed diet

- No sleep disturbances

- He is addicted to alcohol and smoking

Family history :

- There are no similar complaints in the family members

Treatment history : 

- The patient has taken medications for diabetes

- He is not a known case of drug allergy.

General examination : 

Patient is conscious, coherent, cooperative at the time of joining

- No pallor

- Icterus present

- No cyanosis

- No clubbing of fingers and toes

- No lymphadenopathy

- Bilateral pedal edema is present

Vitals : temperature - Afebrile

             Pulse rate - 112 bpm

             Respiratory rate - 22 cycles per minute

             BP - 110/70 mm Hg

Systemic examination : 

CVS

Inspection - chest wall is bilaterally symmetrical

- No precordial bulge 

- No visible pulsations, engorged veins, scars, sinuses, carotid artery was prominent 

Palpation - JVP is not seen 

 Auscultation -  S1 and S2 heard, apex beat is heard in the axillary line in 6th intercostal space

RESPIRATORY SYSTEM

- Position of trachea is central 

- Bilateral air entry is normal

- Normal vesicular breath sounds heard

- No added sounds

PER ABDOMEN 

- abdomen is non tender

- bowel and bladder sounds heard

- free fluid is present

Inspection - shape - generalised distension due to fluid

                      Umbilicus - inverted

                      No visible pulsations

                      No visible peristalsis

                    No striae or prominent superficial veins seen 

                    No IVC obstruction

Palpation - non tender

Percussion - shifting dullness and fluid thrill is present

Auscultation - bowel sounds heard

Provisional diagnosis : cardiomegaly and chronic liver disease secondary to alcoholism

Investigations : 

Final diagnosis : heart failure with de compensated liver disease and hemiscrotal abscess 

Treatment : 

Fluid and salt restriction

Inj. Lasix IV/BD

Inj. Tramadol (1amp in 100 ml NS) IV BD

Inj. Vitamin K 10 mg IM OD

Inj. Metrogyl 100 ml IV/TID

Tab. Aldactone 50 mg PO/OD

Tab. Carvidelol 3.125 mg PO/OD

Tab thiamine 100 mg PO/OD

Tab. Ultracet 1/2 PO/OD

Tab. Udiliv 150 mg PO/BD

Tab. Metformin 500 mg PO/OD

Tab. Chymerol forte PO/TID

Syp. Lactulose 15 ml PO/HS