This is an E log book to discuss our patient's de-identified health data shared after taking his guardian's signed informed consent. Here we discuss our individual patient problems through series of inputs from available global online community of experts with an aim to solve those patient's clinical problems with collective current best evidence based inputs. This e-log book also reflects my patient centered online learning portfolio and your valuable comments in comment box are most welcomed 

I have been given this case to solve in an attempt to understand the topic of "Patient clinical data analysis" to develop my competency i reading and comprehending     clinical data including history, clinical findings, investigations and come up with a diagnosis and treatment plan.   

K. Tejarshini (Intern) 

A 46 year old male came to opd with complaints of, 

Fever on and off episodes:12 days

Loss of appetite:12 days

Pedal edema:7 days

Shortness of breath :7 days

Jaundice:7 days

Patient was apparently asymptomatic 12 days back then he complained of fever which is low grade, intermittent, on and off episodes get relieved on medication. 

Patient complained of B/L pedal edema(grade 2)present below the knees, pitting type, present since 7days which get aggravated on standing for long periods and slightly reduced on taking rest. 

Shortness of breath present since 7 days which is grade 2(developing shortness of breath while walking to washroom). 

Patient also complained of loss of appetite :12 days

Patient also complained of abdominal tightness, bloatimg of abdomen. 

No History of chest pain, chest tightness, palpitations. 

No History of abdominal pain, vomitings, constipation, loose stools. 

No History of burning micturition, decresaed urine output. 

No bowel and bladder irregularities. 

No Head ache, Giddiness, Confusion. 

PAST HISTORY:

Known case of HTN since  3 years and medication. 

Not a K/C/O DM, Asthma, TB, Epilepsy, CAD, CVA. 

PERSONAL HISTORY:

Appetite:Normal(Decreased since 12 days) 

Diet:Mixed

Bowel and Bladder habits:Regular

Addictions:

Consumes Alcohol since 25 years regularly (daily Quarter) 

Tobacco chewing since 5 years. 

GENERAL EXAMINATION:

Conscious, Coherent, Co-operative

Pallor-Present

Icterus-Present


Cyanosis-Absent

Clubbing-Absent

Lymphadenopathy:Absent

Pedal edema- B/L Pedal edema present upto knees




Raised JVP



Vitals:

TEMPERATURE: Afebrile
PULSE RATE:100 beats /min
RESPIRATORY RATE:16Cycles/min
BP:110/70mm of hg 
SPO2:98% at room air
GRBS:#183mg%

SYSTEMIC EXAMINATION:

Respiratory System : Bilateral air entry present.Normal vesicular breath sounds heard.Position of trachea central.

Central Nervous System : patient is conscious coherent and cooperative. Higher mental functions intact 

Cardiovascular System: S1S2 +

Per abdomen:
Inspection:
Shape of Abdomen:Distended
Umbilicus:Everted
No Dilated veins, visible peristalsis, engorged veins, scars, sinuses. 
Palpation:
No local rise of temperature, non-tender
Abdominal girth:89cms 
Liver palpable (15cm) 
Spleen not palpable
Percussion:
Resonant note heard
Auscultation:
Bowel sounds heard. 





INVESTIGATIONS:

Hemogram:
HB:7.9
TLC:43000
RBC:2.36
PLT:1.5

LFT:
TB:19.61
DB:16.08
SGOT:63
SGPT:25
ALP:268
TP:6.1
ALB:2.0
A/G RATIO:0.51

RFT:

S. CREATININE:0.6
S. URIC ACID:4
BLOOD UREA:17
S. ELECTROLYTES:
SODIUM:139
POTASSIUM:4.0
CHLORIDE:103
IONIZED CALCIUM:1.01

BGT:O+ve
BT:2min 30sec
CT:5min 00sec
APTT:51sec
PT:1.85
INR:25sec

RBS:183mg/dl

2D ECHO:





USG ABDOMEN:




ASCITIC TAP DONE ON 13/01/23
ASCITIC FLUID
SUGAR:90
PROTEIN:1.0
LDH:147
ALB:0.51
SAAG:1.5
High SAAG indicates Portal Hypertension

Endoscopy done on 17/01/23






DIAGNOSIS:
DECOMPENSATED LIVER DISEASE, DIMORPHIC ANEMIA WITH THROMBOCYTOPENIA (RESOLVED) WITH HYPOOKALEMIA WITH HEPATIC ENCEPHALOPATHY-GRADE 1(RESOLVED) WITH DENOVO DM-2,? SBP

TREATMENT:
Inj. MONOCEF 1gm IV) BD
Inj. THIAMINE 200mg  in 100ml NS IV/OD
Tab. DOLO 650mg PO/SOS
Inj. LASIX 20mg IV/BD
Tab. RIFAGUT 550mg PO/BD
Tab. UDILIV 300mg PO/BD
Syp. LACTULOSE 15ml PO/BD
Inj. VIT K 10mg IV/OD
Syp. HEPAMERZ 10ml PO/TID
2 Egg Whites/day
Tab. ALDACTONE 50mg PO/OD
Tab. DOXY 100mg PO/BD
Inj. VIT B12 1500mcg IV/OD x7 days
Tab. FOLIC ACID 5mg PO/BD







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