A 33 year old male patient with bilateral pedal edema,abdominal distension and swelling of scrotum
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Case:
A 33 year old male patient with bilateral pedal edema, abdominal distension and swelling of scrotum since 2 months
History of present illness:
Patient was apparently asymptomatic back before the standing illness.Then the patient noticed bilateral pedal edema,swelling in scrotum and abdominal distension since 2 months.
It all started 3 years back where had bilateral pedal edema and abdominal distension and visited a local hospital.There it was diagnosed that patient had liver disease and also that patient had diabetes.
Patient was using metformin for diabetes.
8 months back patient had abdominal distension and yellowish discoloration for which he used herbal treatment but instead of relieving his symptoms,it got aggravated and patient was admitted to the ICU with complaints of severe shortness of breath and abdominal distension on 02/12/21 (Thursday night) where it was diagnosed that patient had dilated cardiomyopathy second to alcohol consumption with chronic liver disease with type 2 diabetes mellitus.
2 months back patient stopped taking medication and followed by which he had bilateral pedal edema extended upto scrotum and also abdominal distension.
Patient was married 10 years back and due to family issues he got separated from his wife and children after which patient was addicted to alcohol consumption.
Past history
He's a k/c/o DM -2 since 2 years and under treatment of Tab Metformin 500 mg
K/c/o HFrEF since 6 months , Chronic liver disease since 3 years
No history of HTN/Epilepsy/TB/Thyroid disorders
The patient had not undergone any surgeries.
Personal history
Diet : mixed
Appetite : decreased
Bowel and bladder : normal
Sleep :adequate
Addictions:Pt had habit of smoking and alcohol consumption since 10 years.
Family history
No history of DM/HTN/CVA/CAD/Asthma/thyroid disorders
No similar complaints in the family previously.
Treatment history
Not significant.
General examination
Patient is conscious, coherent and cooperative.
Pt had h/o jaundice.
No pallor,no cyanosis,no clubbing,no lymphadenopathy.
Vitals
Temp - febrile (99.2 degree Fahrenheit)
PR - 112 bpm
RR - 22 cpm
BP - 110/70 mmHg
SPO2 - 99 %
GRBS - 175 mg/dl
Systemic examination:
CARDIOVASCULAR SYSTEM:
Inspection:
Chest wall is bilaterally symmetrical.
No precordial bulge
No visible pulsations, engorged veins, scars, sinuses
Palpation:
JVP: normal
Auscutation:
Normal with regular heartbeat
S1, S2 heard
No murmurs
Apex beat 5th intercostal space.
JVP elevated
RESPIRATORY SYSTEM-
Position of trachea: central
Normal Bilateral air entry
No AV sounds
PER ABDOMEN:
Patient had distended abdomen
Patient had dilated veins on abdomen.
Fluid thills present.
Normal. No mass is palpable.
No organomegaly
No bruit heard
CENTRAL NERVOUS SYSTEM:
Patient is Conscious
Speech: normal
Reflexes: present
Investigation:
Hemogram :
HB - 13
TLC - 12,100
N/L/E/M - 67 /20/10/3
PCV - 37.8
PLt - 3.13
RBC - 4.81
RFT :
Urea - 31
Creatinine - 0.7
Uric acid - 2.7
Calcium - 10
Phosphorous - 3.8
Sodium - 130
Potassium - 3.6
Chloride - 91
LFT :
TB - 7.26
DB -4.21
AST - 26
ALT - 17
ALP - 560
TP - 6.6
Albumin - 3.6
A/G ratio - 0.24
Ultrasound :
1.altered echotexture of liver with mild surface irregularity ?chronic liver disease
2.Raised echogenicity of B/L kidneys
3.Gall bladder wall edema
4.Gross ascites
5.Skin and subcutaneous tissue shows edematous changes in the anterior abdominal wall diffusely
Clinical images:
Pt had abdominal distension:
Bilateral pedal edema until the scrotum
Echocardiography
ECG
Diagnosis :
HFrEF
with Chronic Liver Disease
with type 2 diabetes mellitus
Treatment :
1.fluid restriction <1.5 l /day
2.salt restriction <2.4 g/day
3.Tab Lasix 40 mg po/bd
4.Tab Aldactone 50 mg po od
5.Tab Met xl 12.5 mg po bd
6.Tab Thiamine 100 mg po bd
7.daily weight and abdominal girth monitoring
8.I/O charting
9.Monitor vitals -4th hourly
10.Grbs - 6th hourly
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