alcoholic liver disease.pptxbkbbkmvvjhjkl

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1. Case presentation name : Rekha s final year MBBS, BGS GIMS , bangalore

2. Patient particulars Name : Mr. Manjunath Age : 45 years Sex : male Education :10 std Occupation : water supplier Socioeconomic status : lower middle class Date of admission : 5/10/2021 Date of examination : 11/10/2021

3. Chief complaints Abdominal distension since 15 days Swelling of lower limbs since 12 days

4. History of presenting illness Patient was asymptomatic before 15 days when he developed abdominal distension which was insidious in onset , gradually progressive , started initially around the lower abdomen and currently uniform distended abdomen with no aggravating and relieving factors Abdominal distension was not associated with pain abdomen He had no h/0 vomiting , constipation no h/o breathlessness ,chest pain No h/o orthopnea , PND No h/o decreased urine output , facial puffiness

5. Patient complaints of swelling of lower limbs Present since 12 days ,insidious in onset , gradually progressive Initially noticed around the ankle and currently progressed till thighs No aggravating and relieving factors No h/o fever No h/o pain and redness of limbs No h/o breathlessness No h/0 decreased urine output

6. no h/o fever No h/o pain abdomen No h/o itching , clay coloured stools , high coloured urine No h/o vomiting blood , blood in stools No h/o breathlessness No h/o involuntary movements ,altered sensorium ,change in sleep pattern No h/o decreased urine output No h/o decreased appetite and weight loss

7. Past history He had similar complaints of abdominal distension 10 months back and was treated for the same and it reduced he has no h/o diabetes , hypertension , tuberculosis No h/o tattoo, piercing , blood transfusion No h/o past surgical intervention

8. Drug history He is on antihypertensive drug since a year He has no h/o allergies to any drugs in the past

9. Family history

10. Personal history He consumes a mixed diet Appetite normal Sleep – undisturbed Bowel and bladder movements : regular Addictive habits : he consumes alcohol since 20 years whiskey-180 ml / day – 6 units No h/o smoking , iv drug abuse

11. Summary A 45 year old male who is a chronic alcohol consumer presented with abdominal distention and swelling of lower limbs with no other complications

12. General physical examination Patient s consent was taken Patient is well built and nourished Patients is conscious ,cooperative and well oriented to time place and person Pallor : absent Icterus : present Cyanosis : absent Clubbing : absent Lymphadenopathy : absent Edema : present till knees – pitting type

13. Vitals Pulse : 68 /min normal in rate ,rhythm , character , volume , arteries non palpable ,no delays present Blood pressure : 118/80 mm of hg measured in right arm sitting position Respiratory rate : 18 cycles / min , thoracoabdominal Temperature : afebrile ( 98.4 F)

14. Head to toe examination No alopecia No loss of eyebrows No xanthelasma no parotid enlargement No bad breath No spider naevi No palmar erythema , dupuytrens contracture Nails : normal No tremors No gynacomastia No loss of axillary and pubic hair No dilated veins over abdomen No testicular atrophy No petechiae ,purpura

15. SYSTEMIC EXAMINATION ABDOMINAL EXAMINATION : Patient s consent was taken and examined under adequate exposure and light Inspection : Generalized distension of abdomen , flanks appear full Skin is glossy Umbilicus : everted All quadrants move equally with respiration No visible veins , sinuses , scars No scratch marks

16. Palpation : done in supine position with both lower limbs flexed No local rise of temperature No tenderness No guarding , rigidity Liver palpable : 7 cm below the right costal margin , firm in consistency ,edges are round ,smooth surface , non tender Spleen : non palpable

17. Abdominal girth : 108 cm xiphisternum to umbilicus : 39 cm umbilicus to pubic symphysis : 24 cm umbilicus to anterior superior iliac spine : right : 38 cm left : 38 cm

18. Percussion : Liver dullness upper border – fifth intercostal space on full expiration lower border – dullness extends 7cm below costal margin in midclavicular line Total liver span : 17 cm Shifting dullness : present

19. Auscultation Bowel sounds heard – 4 per minute No venous hum No bruit heard Genitilia examination : normal

20. Respiratory system : Normal vesicular breath sounds heard . No added sounds Cardiovascular system : first and second heart sound heard ,no murmurs Nervous system examination : no focal neurological deficit . No tremors present

21. Provisional diagnosis A 45 year old male with a history of consumption of alcohol since 20 years presented with abdominal distension and swelling of lower limbs suggestive of liver pathology and the likely cause is chronic alcohol consumption and my probable diagnosis is decompensated liver disease with ascites with no features of its complications .

22. Investigations Blood profile Liver function tests Electrolytes Renal function tests Ultrasound abdomen Hepatic elastography Ascitic fluid examination

23. Management Diet : high protein diet reduced salt intake Diuretics Liver transplant

24. Thank you