66 year male with ascites

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



66yrs elderly male resident of jagatpally toddy climber by occupation presented to opd with c/o abdominal distension since 1 1/2 month

Nausea, decreased appetite since 1 1/2month 

Decreased urine output since 10days

Constipation since 2days


Pt was apparently asymptomatic 2months back he noticed abdominal distension after intake of food , associated with nausea, pain abdomen at epigastric region 

So he reduced his daily intake of food

Patient attenders noticed that he is reducing body weight.

He is complaining of decreased urine output since 10days .

Not passing stools since 2days,passing flatus.

C/o B/L swelling of lower limbs up to ankle region pitting type.

No h/o facial puffiness

No h/0 shortness of breath,palpitations 

No h/0 fever, cough


H/0 fall from tree while climbing 5yrs back


No h/0 htn, dm, cad, Tb, asthma


Pt is occasional alcoholic 

Non smoker

Gutka chewer

Takes mixed diet


Pt is conscious,coherent, cooperative

Moderately built,moderately nourished

Temp- 98.6f

Bp- 120/70mmhg

Pr- 98bpm

Rr- 16cpm

Spo2-98% at ra


Jvp- normal

No pallor, icterus, cyanosis, clubbing ,lymphadenopathy 



P/a - distended,no visible pulsation, engorged veins

Tenderness + at epigastric,rt lumbar region

Fluid thrill present

Bs- present

 



Resp BAE+

Cvs- s1 s2 +

Cns- higher mental functions intact


Ascitic tap done



 SAAG - 0.5

Sugars- 78

Proteins- 3.9


Cellcount -

Tc-1155(corrected wbc count)

Dc- 80%lympochytes, 20%_ neutrophils


LDH 340(normal)


Low saag with lymphocytic predominance 

*******

ESR- 70mm


Hb-10.1

Tlc- 11,000

Plt- 5 lakhs


Tb - 1.67

Db- 0.22

AST-19

Alt-17

All-175

Sr alb-2.7


Urea-58

CT-1.2


Na-134

K-5.0

Cl-99


Serum amylase 1098


Ascites under evaluation

?Tubercular ascites

?peritoneal carcinomatosis

?peritonitis


CECT abdomen



Mantoux test done



Sputum for CBNAAT negative


Ascitic fluid hemoglobin,PCV




Serum lipase




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