ALCOHOLIC LIVER DISEASE

 

Hello everyone.. I am varshitha , an intern posted in medicine department and one of the important terms of getting the internship completion is to complete my log book with my online log of what I learn during the course of my duties.

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 problems with collective current best evidence based inputs.

This E log book also reflects my patient-centred online learning portfolio and your valuable inputs on the comment box is welcome

Here is a case I have seen-

A 55 year old male who is a farmer by occupation came  to the opd with the complaint of abdomen distension since 1 week associated with b/l pedal oedema 

HISTORY OF PRESENT ILLNESS

Patient was apparently asymptomatic 10 years back , then he noticed abdominal distension associated with b/l pedal oedema for which they went to kamineni hospital where the patient was told that he had fluid in his abdomen and it had to be removed and as told by the patient attender- the fluid was drained from the abdomen,and was put on medications for a month ( no record of medication) , he used them for a month and had relief of symptoms .During this period he had no 

c/o pain abdomen , yellowish discoloration,constipation,fever, dark coloured urine

Now the patient presented to the opd (17/09/2020)with similar complaints of 

abdominal distension since a week associated with b/l pedal oedema pitting type and shortness of breath

No h/o bleeding per rectum, constipation,dark coloured urine , nausea , vomitings,bleeding manifestations, blood transfusion

facial puffiness, itching, fever, involuntary movements, altered sleep wake cycle, headache, myalgia

Past History

Patient has similar complaints 10 years back ie;  bilateral pedal oedema  for which he got admitted in kamineni hospital and was treated for same 

Personal History 

Patient has a mixed diet, normal appetite with regular bowel and bladder movente, adequate sleep 

He is a chronic alcoholic since 15 years , evryday he drinks 90 ml whisky , smokes 3-4 beedis evryday 

Family History- not significant 

General examination 

Pt was conscious coherent cooperative 

moderately built and nourished 

Vitals - afebrile , bp- 110 /80 mmhg , pr- 86bpm rr- 16cpm

Systemic examination 

P/A - 

INSPECTION- 

Abdomen distended,umbilicus everted transversely slit, flanks full, no visible pulsations,perlistasis,engorged veins, scar in Rt. hypochondrium,swelling noticed in periumbilical region

PALPATION-

All inspectors findings are confirmed,swelling in peru umbilical region about 3*2 cm, soft and non reducible

cough impulse present

AUSCULTATION-

Bowel sounds present

PERCUSSION-

dull note present in flanks

shifting dullness present

fluid thrill present

RS-

BAE present , no added sounds , trachea midline

CVS -

S1 S2 heard , no murmurs 

CNS -

Higher mental functions - normal

Motor system - intact 

Sensory system- intact 

Cranial nerve examaination - normal

                    INVESTIGATIONS 

ASCITIC TaP DONE on 18/09/20 upto 1 litre

ASCITIC FLUID ANALYSIS

                              Chest x ray

ECG

USG ABDOMEN

FEVER CHARTING

Patient assessed for any features of encephalopathy by doing the following psychometric tests

Treatment

1. Fluid restriction upto 1.5 l/day
2. salt restriction upto 2 mg/day
3. syrup lactulose 15 ml/po/hs 
4. tab rifaximine 550 mg po bd
5. tab wasilactone 20/50 mg po bd
6. 3 egg whites / day
7. body weight and abdominal girth monitoring
8. temperature charting

Diagnosis -Alcoholic liver disease with ascitis