Chandana vishwanatham

 30year old male alcoholic since 5years daily 180ml whiskey, occasional toddy Patient was apparently asymptomatic 1year ago developed Yellowish discoloration of eyes 1year ago(bilirubin was 9mg/dl),not associated with any abdominal distension,used herbal medication,jaundice subsided. stopped alcohol for 3months after that. He was fine and he again started taking toddy daily .3months later he again developed yellowish discoloration of eyes (TB was 20mg/dl 6 months ago) Last intake of alcohol 3months ago Since 1 week Patient is c/o B/L pedal edema gradually progressed upto knees  Abdominal distension since 1 week Yellow discoloration of eyes and urine since 1 week Dry cough since 6days shortness of breath since 5days High grade fever since 2-3days ,not associated with chills and rigors, intermittent loss of appetite,easy fatiguability since 3days No h/o facial puffiness,burning micturation,vomitings,loose stools,hematemesis,malena bowel and bladder habits regular not a k c o DM,HTN,CAD,C

 52year old male toddy tree climber by occupation came with c/o decreased urine output since 2days and anuria since 1day Grade 4 sob since 1day Pt was apprently normal 10years ago  10years ago operated for rt inguinal hernia,pt was fine after the surgery but had on and off pain at the surgical site which aggrevated since 3years so he stopped climbing toddy trees and h/o NSAID abuse for pain since 3years H/o facial puffiness on and off since 2yeaes 1yr ago pt had h/o SOB grade 2 for which he visited local hospital and was diagnosed to be hypertensive (?unknown medication) Since 2-3 months on and pedal edema ,urine output was normal at that time 2 days h/o decreased urine output and anuria since today mrng H/o constipation since 2days Since 2 days sob grade 2 which progressed to grade 4 today for which he visited local rmp and was referred here No h/o fever ,cold ,cough,loose stools No c/o palpitations,giddiness ,sweating K/c/o HTN since 1 year Not a k/c/o DM,CAD,CVA,ASthma,TB, epilepsy