27 yr male with yellowish discolouration of eyes and generalised weakness
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CHIEF COMPLAINTS
Yellowish discolouration of eyes since 2 years
Swelling of feet since 20 days
Generalised weakness since 20 days
Loss of appetite since 20 days
Fever since 2 days
HISTORY OF PRESENTING ILLNESS
Patient was apparently asymptomatic 2 years ago then he developed weakness along with loss of appetite for past few weeks with yellowish discolouration of eyes
20 days back patient complaints of similar symptoms of generalised weakness which was insidious in onset and gradually progressive ,comparatively increased weakness from the last two episodes in past 2 years ,weakness is associated swelling of feet confined Upto the ankles present throughout the day ,which increases on walking and decreases while lying down or leg raising
No h/o chest pain ,palpitations,facial puffiness or decreased urine output
He also had yellowish discolouration of eyes since 2 years which was gradual in onset and gradually progressive,associated with high coloured urine since 2 years , Patients complaints of darkly stained stools 20 days back only one such episode
No h/o constipation,diarrhoea.
He also had blood in urine since 10 days and not associated with deceased urine output ,increased frequency, urgency , burning micturation,foam in the urine
Patient complaints of low grade fever since 2 days which was insidious in onset and continuous in type and relieved only on medication
No h/o of night sweats , chills and rigor ,myalgia ,joint pain ,rash .
Patient also complaints of increased sleepiness during the day and sleeplessness at night since 10 days
H/o of tremors ,palpitations,fearfulness ,sweating if he stopped alcohol since 1 year
No h/o difficulty in breathing ,orthopnea ,PND ,hematemisis ,foul smelling breath , ,abdominal distension ,abdominal pain ,nausea ,vomitting ,loose stools .,confusion,altered sensorium
PAST HISTORY
Two episodes of jaundice in the past two years for which he was taken to the hospital and declared a case of chronic liver failure .
N/k/O HTN ,DM ,TB,asthma ,heart disease ,seizures
TREATMENT HISTORY
deaddiction medication for a week 2yrs ago
FAMILY HISTORY
No similar complaints in the family
PERSONAL HISTORY
DIET -mixed
APPETITE -decreased since 2 years
BOWEL BLADDER - regular
SLEEP - increased sleepiness during day time since last 20 days
ADDICTIONS - alcoholic since 6 years consumes half a bottle everyday,non smoker.
GENERAL PHYSICAL EXAMINATION
Patient is conscious,coherent and co operative well oriented to time place and person ,moderately nourished and moderately built
Pallor -absent
Icterus -present in upper bulbar conjunctiva
Cyanosis -absent
Clubbing - absent
lymphadenopathy -absent
Pedal edema - pitting type Upto ankles was present before now resolved
VITALS
Temp 100.6F
Pulse 74/min
Bp 110/80 mmhg
RR 17/min
SYSTEMIC EXAMINATION
Abdomen
Inspection
Abdomen is scaphoid in shape , no flank fullness
Umbilicus has scar contracture
No engorged veins ,sinuses
No visible peristalsis or pulsations
Palpation
Abdomen is non tender
Rise of temperature seen
No organomegaly
Percussion
Upper border of liver dullness is per used at the right 6 th inter coastal space along the mid -clavicular line on full expiration and the lower border at 5 cms below the rt costal margin
Liver span-12 cms
No fluid thrill
No shifting dullness
Auscultation
Bowel sounds were heard
CNS:
Conscious,coherent and cooperative
DIAGNOSIS:
Acute decompensation of liver with grade 1 hepatic enchelopathy
Investigations:
Usg:
Ecg:
Treatment:
Iv fluids NS@75ml/ hr
Inj thiamine 200 mg iv bd
Tab doxy 100mg
Tab udiliv 300mg
Tab orofer xt
Tab oxazepam 15 mg
Syrup lactulose 30 ml
Syrup hepamerz 10ml
Fudic cream
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