62year female with yellowish discoloration of eyes

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 Admission -13/1/22

60/F came to casualty with c/of pain abdomen since 1 month 

Yellowish discoloration of eyes since 15 days 

Vomitings since 15 days

sob since 15 days 

Decreased appetite since 15 days

Patient was apparently asymptomatic 1 month back 

Had H/of pain abdomen on and off since 1 month - insidious onset, intermittent , diffuse and burning type of pain associated with decreased appetite taking only fluids since 15 days f/by vomitings - bilious, non- projectile, food or water as content whenever patient is taking oral feeds

Yellowish discoloration of eyes since 15 days 

Sob since 15 days inscidious onset gradually progressed from grade 2 to 3 associated with pedal odema and decrease urine output 

not associated with fever, cold, cough, orthopnea and PND

No pale coloured stools, mucous , blood or dark coloured stools 

0/examination: pt-conscious and tachypnic 

Afebrile 

Icterus + 

No pallor, cyanosis, clubbing, lymphadenopathy

PR - 90 bpm 

BP- 130/80 mm of hg 

RR - 34 cpm 

Spo2 -88 with RA 

98 with 2 L of oxygen

GRBS : 85 mg /dl


P/A - soft, tenderness + in epigastric region , right hypochondrium and umbilical region 

R/S : fine crepts + in B/L IAA ,ISA 

Decreased breath sounds in right IAA and ISA 


CVS - S1 and S2+ 

CNS - NAD






















Icu bed 5
Unit 4
Day 2

S:nausea+
    No vomitings
     No fever spikes

O: pt conscious /oriented
Icterus+
Bp:90/60
PR:80
RR:30
Spo2:98%
P/A: distended,free fluid+
         Tenderness+ in rt hypochondrium and epigastric region,bowel sounds+
RS:decreased breath sounds B/L basal areas

USG guided ascitic tapping done
TC : 6400. 70% N,30% L
 RBC+

Pleural fluid analysis :
TC : 505. 70%N,30% L

Total bilirubin : 30
Direct : 19.5
Ast/ALT/ALP: 84/53/895
Alb :2.5
 
Child Pugh score c
MELD SCORE 20

A: OBSTRUCTIVE JAUNDICE SECONDARY TO ?CHOLANGIO CARCINOMA
MODERATE ASCITES
Right PLEURAL EFFUSION

Treatment;
IVF : NS @UO+ 30ml/hr
Inj pan 40mg IV OD
Inj. Zofer 4mg IV/TID
Bp and input output charting
RTPCR for COVID +
Patient referred to higher centre

MRCP done at outside hospital





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