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1. General clinics – Per abdomen case presentation -Manjunatha S

2. Demographic details Name-Mr Kallappa Age-39y Sex-male Address- Nekar nagar,hubli Occupation-labourer Education-10 th Date of admission-20/07/2025 Date of examination-31/07/2025

3. Chief complaints Abdominal distension since 6months Swelling of lower limbs since 5months Yellowish discolouration of eyes since 7days Fever since 3days

4. History of presenting illness Patient was apparently alright 6months back when he noticed abdominal distension Insidious in onset Gradually progressed to current state Distension changes in position Diffuse in nature Not associated with pain abdomen or obstipation or vomiting Not associated with dyspnea

5. Swelling of lower limbs since 5months Insidious in onset Initially involved only the feet but then gradually progressed up to knees Present through out the day and reduces on lying down or legs raised Not associated with scrotal swelling No history of chest pain or palpitations No history of facial puffiness or decreased output

6. Yellowish discolouration of eyes since 7days Acute in onset ,gradually, progressive Noticed by his wife Not associated with itching , high coloured urine or pale stools Fever since 3days Continuous ,high grade ,associated with chills and sweating ,myalgia Relieved on medications Not associated with joint pain ,rash

7. -patient also complaints of increased sleepiness during the day and sleeplessness during night since 5days No history of difficulty in breathing , orthopnea or PND No history hematemesis, blood in stools or malena

8. Past history Episode of jaundice 8months back for which he took native treatment No history of TB, Asthma, DM, hypertension heart disease No history of blood transfusions No history any previous abdominal surgeries

9. Family history No history of similar complaints in family No other significant family history

10. Personal history Non vegetarian Decreased appetite since 1week Disturbed sleep at night and increase sleepiness during daytime Bowel and bladder movements normal Smoking since past 20years 10cigarettes /day -10pack years Alcohol intake of 150ml daily since past 20years No history of IV drug abuse

11. Summary A 39 year old male patient residing in nekar nagar hubballi comes with complaints of abdominal distension since 6months ,swelling of lower limbs since 5months ,yellowish discolouration of eyes since 7days and fever since 3days He has episode of jaundice 8months back for which he took native treatment .patients appetite is decreased and disturbed sleep at night and increased sleepiness during daytime since 1week and he is smoking and consuming alcohol since 20years.

12. General physical examination Here is middle aged male poorly built and poorly nourished ,and is conscious ,cooperative and oriented to time ,place and person Height -150cm wt-45 kg BMI-20kg/m2 Vitals Pulse 74bpm(normal in rate ,rhythm , character and volume no radio-radial or radio femoral delay) Blood pressure-100/64mmhg (measured in right arm in sitting position) RR-17 cycles /minute ( abdomino -thoracic type)

13. Head to toe examination Hair is sparse Parotid swelling in present on both sides Palmer erythema is present Spider naevi are present , 2 on chest and 1 on back Pale coloured nails Gynaecomastia present Flapping tremors are present

14. Pallor –present Icterus-present Edema –present(pedal edema ) Cyanosis-absent Clubbing-absent Lympdadenopathy -absent

15. Systemic examination Abdomen is uniformly distended and flanks are full Umbilicus appears to be displaced downwards and horizontally slit All abdominal quadrants move equally with respiration Skin appears shiny with no stria or scratch marks present No discolouration of skin Engorged veins present over the abdomen No visible peristalsis or pulsations No scars or sinuses On head raising test , no divarication of rectus seen

16. Hernial orifices appear normal External genetalia appears normal PALPATION -Superficial palpation The abdomen is not warm and non tender No Abdominal rigidity or guarding Abdominal girth is 105cm Spinoumbilical distance is 20cm on both sides Xiphoumbilical distance is 24cm and distance from umbilicus to pubic symphysis is 19cm

17. Direction of flow of blood in engorged veins is away from the umbilicus both above and below On deep palpation – No palpable mass appreciated Percussion – Percussion of liver -upper border of liver dullness is percussed at right 5 th ICS along the midclavicular line on full expiration and lower border is not palpable

18. Percussion of spleen Castells method – dullness is observed in the 9 th ICS of the Anterior axillary line Traubes space is dull to percussion Shifting dullness present Fluid thrill was appreciated

19. AUSCULTATION Bowel sounds are present Venous bruit and venous hum are absent. CVS S1 and s2 heard No murmurs heard No additional sounds heard RS – normal vesicular breathe sounds head , No added sounds.

20. Provisional diagnosis My diagnosis for this patient is decompensated liver disease probably cirrhosis of liver with features of portal hypertension due to chronic alcohol consumption