55 year old male with abdominal distension
A 55 year old male came to hospital with complaints of abdominal distension since 1 week
Swelling in both the legs since 1 week
Patient was admitted on 18,November 2021
He was asymptomatic 3 months 15 days ago then he noticed swelling of right lower limb which was gradually progressive .It started as swelling in the foot then progressed slowly from foot to thigh to involve whole leg. Pedal edema was pitting type and associated with pain in muscles
The swelling progressed further to involve abdomen and he developed abdominal distension after 15 days which progressed gradually .15 days later he developed swelling in left leg which started as ankle swelling and progressed upto thigh and involved scrotum
15 days after development of abdominal distension he came to KIMS for treatment. He was admitted here. Ascitic tap was done. He was diagnosed with Nephrotic syndrome .He was given medication for that and discharged.
1 month after that he developed abdominal distension again along with pedal edema and came to KIMS. Then again Ascitic tap was done
The swelling in legs and abdominal distension aggravated since 1 week
He is having sob since 3 months on walking
He also had decreased urine output 3 months ago for 20 days which started at the time of abdominal distension and improved after using medication after admission to KIMS
He also has decreased appetite since 3 months
He underwent dialysis 2 times
1st time was 3 days ago
2nd time was 2 days ago
He is currently using Metolazone for edema(thiazide like diuretic)
He also has a history of joint pains since 6 years .He used to cycle upto 10 Kms every day. He used to take pain killers for joint pains 7 to 8 times a month
No history of burning micturiturition, urgency, increased frequency ,hematuria,frothy urine
Daily routine :
He used to cycle 10 Kms every day for his work. Now because of pedal edema he could not even walk properly and he is not going to work. His food intake is also decreased and is eating almost 1/4 of what he used to eat every day
Past history :
He was diagnosed with hypertension 3 months ago at a local hospital when he went for treatment for swelling .He is using medication since then AMLONG 5mg OD
He was diagnosed with pulmonary tuberculosis 23 years ago and used course of ATT for 6 months
No h/o diabetes, asthma,epilepsy
Treatment history :
Used to consume painkillers for joint pains 7 to 8 times a month
Used ATT for tuberculosis
Personal history :
Diet is mixed
Appetite is decreased since 3 months
Sleep - adequate
Bowel - constipated because of reduced food intake
Bladder - decreased urine output
No addictions
Family history:
Not significant
General examination :
Patient is conscious,coherent,cooperative well oriented to time, place and person
Moderately built, moderately nourished
Pallor - present, edema - present
No signs of Icterus, cyanosis, clubbing, lymphadenopathy
Vitals:
Bp: 130/90
PR: 96bpm
RR:24 cpm
Temperature -
Respiratory examination :
B/L air entry present
Auscultation -Normal vesicular breath sounds heard
Cardiovascular system :
S1, S2 heard, JVP is raised, murmurs are heard over aortic region
Per abdomen examination :
Inspection :
Abdomen is distended,skin over abdomen is tense
Umbilicus is central
Palpation :
Abdomen is non tender, temperature is same as that of surrounding
Percussion :
Dull note is heard over all the quadrants
Fluid thrill was present
CNS examination :no abnormality detected
He has pitting type of pedal edema
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