49 yrs old female with abdominal distension and pedal edema

A 49 YEAR OLD MALE CAME WITH ABDOMINAL DISTENSION AND PEDAL EDEMA.CASE SHEET:

Chief complaints:

A 49 year old male, driver by occupation came to causality with chief complaints of:
- Abdominal distention since 10 days
- pedal edema since 10 days

HISTORY OF PRESENT ILLNESS:

The patient was apparently asymptomatic 20 years back. At age of 10, he developed seizures, which subsided itself without any medication.

10 years back, patient has scaly lesions on hands and legs for which he was diagnosed as psoriasis. Since then he was on regular medication.

A year back, the patient has yellowish discoloration of sclera for which he used herbal medicine for 6 days. Again after 3 months, he had similar case of yellowish discoloration of sclera for which he used herbal medicine for 7 days.

He had yellowish discoloration for 20 days and distention of abdomen for 10 days and pedal edema for 10 days.

ASSOCIATED DISEASES:

No significant diseases.

PAST HISTORY:

The patient was a known case of psoriasis 20 years back.

PERSONAL HISTORY:

Diet: Mixed
Bowel : constipation since 20 days
Micturition: Burning micturition 
Appetite: Decreased
Habits: Regular alcoholic since 7 years
No history of allergy, asthma, tuberculosis, coronary artery disease.

FAMILY HISTORY:

No significant family history.

DRUG HISTORY:

No significant drug history

GENERAL EXAMINATION:

No pallor
No cyanosis
No clubbing
No lymphadenopathy
No malnutrition
No dehydration
Icterus present
Pedal edema 
VITALS:

Temperature: 98.4 F

Pulse: 89 beats per minute

Respiratory rate: 16 cycles per minute

Blood pressure: 120/70 mm of Hg

SPO2: 99%

SYSTEMIC EXAMINATION:

Cardiovascular system:

No thrills
No murumurs
Cardiac sounds: S1, S2 heard

Respiratory system:

No dyspnea
No wheezing
Breath sounds heard: vesicular

Abdomen:

Shape: distended
No tenderness
No palpable mass
Non palpable liver
Non palpable spleen
No bruits
Bowel sounds: heard

Central Nervous System:

Conscious
Speech: normal

INVESTIGATIONS:
Biochemical investigations

Treatment-
TAB: LASIX 40mg po/td
TAB: SPIRINOLACTONE 100mg po/od
TAB: UDILIV 300mg po/bd
TAB: RIFAGUT 550mg po/bd
SYRUP: LACTULOSE 30ml po/td
INJ: VITAMIN K (amp) 100 ml iv/od
PROTIENEX POWDER IN 100ml of milk po/td
TAB: PANTOP 40mg po/od
 BENZAC- AC GEL - od (face) 2 weeks
MOISTUREX SOFT LOTION - (body) 2 weeks
TAB: VIBOLIV 500mg po/bd
TAB: MAXILIV 500mg po/bd
TAB: ANTIOXID po/od
E/D: LUBREX 5 times/day
TAB: PREDNISOLONE 20mg po/odPROVISIONAL DIAGNOSIS:
Chronic liver disease.

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