Case 2 46yr male admission 28/04/23

discharge 03/05/23 39 years old male Case no. 3 Admission date 02/10/2023 Discharge date 06/10/23 Diagnosis DECOMPENSATED CHRONIC LIVER DISEASE SECONDARY TO ALCOHOL SUBACUTE BACTERIAL PERITONITIS ANEMIA SECONDARY TO NUTRITIONAL ? B12 DEFICIENCY Case History and Clinical Findings C/O PAIN ABDOMEN YELLOWISH DISCOLORATION OF EYES ABDOMINAL DISTENSION PEAL EDEMA SINCE ONE MONTH HOPI : PATIENT WAS APPARENTLY ALRIGHT 1 MONTH BACK THEN HE HAD PAIN ABDOMEN IN THE EPIGASTRIC REGION AND UMBILICAL REGION WHICH IS TWISTING TYPE OF PAIN , NON RADIATING , NOT AOCIATED WITH NAUSEA , VOITINGS , OR LOOSE STOOLS ABDOMINAL DISTENSION SINCE ONE MONTH PEDAL EDEMA SINCE 1 MONTH WHICH IS PITTING TYPE FEVER + SINCE 1O DAYS , LOW GRADE , ONLY EVENING RISE OF TEMPERATURE NO CHEST PAIN , SOB , PALPIATIONS . NO MALENA , HEMATURIA , HEMATEMESIS PAST HISTORY : N/K/C/O DM , HTN , THYROID DIORDERS , CVA , CAD PERSONAL HISTORY: MIXED DIET APPETITE IS NORMAL BOWEL AND BLADDER - REGULAR ADDICTIONS: ALCOHOLIC SNCE 20 YEARS [DAILY 90ML} GENERAL EXAMINATION: PATIENT IS CONSCIOUS,COHERENT,COOPERATIVE PALLOR+ NO SIGNS OF PALLOR,ICTERUS,CLUBBING,CYANOSIS ,LYMPHADENOPATHY,EDEMA VITALS- TEMP- 98.5 PR- 98 BPM RR- 18CPM BP-110/60MMHG SPO2- 98% AT RA NO CHEST PAIN , SOB , PALPIATIONS . NO MALENA , HEMATURIA , HEMATEMESIS Investigation HB : 7.1 PCV : 21.2 TLC : 5000 RBC : 2.04 PLATEELET COUNT : 1.5 PT : 18 SECINRV: 1.33 APTT : 35 SEROLOGY : NEGATIVE RBS : 142 RFT : UREA : 21 CREATININE : 0.8 2/10/23 4/10/23 NA : 136 137 K : 3.7 3.8 CL: 98 104 LFT : 2/10/23 3/10/23 TB: 3.17 2.40 DB : 1,.64 1.94 AST:58 47 ALT : 28 22 ALP :263 251 TP :6.2 6.4 ALBUMIN : 2.2 2.76 A/G : 0.55 0.76 CA IONIZED : 1.01 1.20 ASCITIC FLUID CYTOLOGY : SHOWS PREDOMINANTLY DEGENERATED NEUTROPHILS , FEW LYMPHOCYTES , MESOTHELIAL CELLS IN AN PROTIACIOUS BACKGROUND NO EVIDENCE OF ATYPICAL CELLS ASCITIC FLUID SUGAR- 171 MG/DL ASCITIC FLUID PROTEIN- 1.5 GM/DL ASCITIC FLUID LDH-207 IU/L CELL COUNT OF ASCITIC FLUID: APPEARS CLEAR COLOR-PALE YELLOW TOTAL COUNT-300 CELLS/CUMM NEUTROPHILS-70% LYMPHOCYTES- 30% RBC-NIL FEW MESOTHELIAL CELLS SEEN VOLUME - 2ML SERUM ALBUMIN - 2.2 GM/DL ASCITIC ALBUMIN - 0.4 GM/DL SAAG- 1.8 Treatment Given(Enter only Generic Name) 1. FLUID RESTRICTION <1.5 LITRES /DAY 2. SALT RESTRICTION <2 G /DAY 3. INJ PAN 40 MG IV /OD 4. INJ CEFOTAXIME 2 GM IV /TID X 4DAYS 5.INJ VITCOFOL 2500 MG IM/OD X 6.TAB . LASIX 20 MG PO /BD 7.TAB.UDILIV 300 MG PO/BD 8.TAB.BENFOMET PLUS PO /BD 9.2-3 EGG WHITES /DAY Advice at Discharge 1. FLUID RESTRICTION <1.5 LITRES /DAY 2. SALT RESTRICTION <2 G /DAY 3. TAB.PAN 40 MG IV /OD X 3 DAYS 4.TAB.TAXIM 200MG PO/BD X 3 DAYS 5.TAB.LASIX 20MG PO/BD X 1 WEEK 6.INJ.VITCOFOL (2500MG) ALTERNATE DAY X 1 WEEK WEEKLY ONCE X 1 MONTH MONTHLY ONCE X 3MONTHS 7.TAB.UDILIV 300 MG PO/BD X 1 WEEK 8.TAB.BENFOMET PLUS PO /BD X 1 WEEK 9.2-3 EGG WHITES /DAY On Follow up patient reported he is doing fine