case presentation on ASCITES

Ascites is the pathologic accumulation of fluid within the peritoneal cavity. It is the most common complication of cirrhosis and occurs in about 50% of patient with decompensated cirrhosis in 10 years. The development of ascites denotes the transition from compensated to decompensated cirrhosis.
The main symptoms of ascites are a large belly and rapid weight gain.

Other symptoms include:

Swelling in your ankles.
Shortness of breath.
Digestive issues, such as bloating, abdominal pain, loss of appetite, indigestion and constipation.
Back pain.
Difficulty sitting.
Fatigue.

1. CASE PRESENTATION ON ASCITES

2. PATIENT DETAILS: Patient Name: Kiran Age: 60yrs Sex: male IP No: 2511 DOA: 2/11/22 DOD:10/11/22 Department: GMW CHIEF COMPLAINTS: Abdominal distention No urine output for 2 days

3. ON EXAMINATION Temp: 98.6 Pulse Rate: 85 b/m SPO2 : 96% BP : 120/90 mmHg Social History : Diet : Non veg Alcohol : Yes , since from 10yrs

4. PAST MEDICAL HISTORY Hypothyroidism Diabetes Hypertension

5. PAST MEDICATION HISTORY Levothyroxine : 25mcg Irregular drug use for diabetes Amlodipine : 5mg

6. LABORATORY INVESTIGATIONS Parameters Observed Values Normal Values Units Hemoglobin 9 14- 16 g/dl ESR 80 1- 7 mm/ hr Platelet Count 2,00,000 1,50,000-4,00,000 Cells/ cumm RBC 2.8 3.8-5.8 Millions/ cumm Neutrophils 80 40-75 % Lymphocytes 10 20- 45 % Serum Creatinine 1.8 0.6-1.2 mg/dl

7. LABORATIRY INVESTIGATIONS Parameters Observed Value Normal Value Units Na+ 133 134-155 mEq /l Chlorides 81 98-107 mEq /l Fasting Blood Sugar 130 70-110 mg/dl Random Blood Sugar 266 110-180 mg/dl TSH 0.38 0.35-4.0 mlu /ml FT4 1.0 0.8-1.8 ng /dl FT3 3.5 2.3-4.2 pg /dl

8. US- ABDOMIN ;

9. IMPRESSION ; M oderate free fluid seen in the abdomin . Bilateral moderate pleural effusion. DIAGNOSIS : ASCITES

10. Definition : Ascites is defined as the accumulation of free fluid in the peritonial Cavity. ETIOLOGY : It can be caused due to the liver problems like cirrhosis, acute liver failure, others like heart failure, nephrotic syndrome, disorders of pancreas.

11. Pathophysiology :

12. Present MEDICATION HISTORY : s.no Brand Name Generic Name R.O.A Dose Frequency 1. Uribid Nitrofurantoin po 100mg OD 2. Thyronorm Levothyroxine po 25mcg OD 3. Ursocol Ursodeoxycholic po 300mg OD 4. Glyset Miglitol po 25mg BD 5. Norvasc Amlodipine po 5mg 0D 6. Pantop Pantaprazole po 40mg 0D 7. Benfoplus Folicacid ….. …….. BD 8. Aldactone spironolactone po 100mg BD

13. SOAP NOTES : Subjective – Abdominal distension, no urine output for 2days. Objective – Hb ; 9gm ESR ; 80mm/ hr RBC; 2.8 Neutrophils; 80 Lymphocytes; 10 Na+; 133 Serum creatinine ; 1.8 Cl -; 81 FBS; 130 RBS; 266

14. Assesment ASCITES PATIENT COUNSELLING : Limit alcohol intake. Weight loss Exercising Limit salt intake Once it is arrived, to check that not to be prone.

15. Presented By: M. Durga rohitha pharm-d IV year 174T1T0005