Facial puffiness with associated pedal edema

 June 11, 2023

This is an online E logbook to discuss our patient’s de-identified health data shared after taking his/her/guardian’s signed informed consent. Here we discuss our individual patient’s problems through series of inputs from an available global online community of experts to solve those patients clinical problems with collective current best evidence-based inputs. This e-log book also reflects my patient-centered online learning portfolio and your valuable inputs on the comment box are welcome.

a 53-year-old male, a Hotel owner and chef by occupation,

The patient presented to the hospital with chief complaints of

  • Swelling of both Legs since 10 days
  • Swelling of face since 7 days


HISTORY OF PRESENTING ILLNESS 

The patient was apparently asymptomatic 10 days ago.In the first week of June he had a binge of alcohol on occasion of local festival. Later he observed abdominal distension, followed by Bilateral Pedal odema which is pitting type extending up to the knee, insidious in gradually progressive , since one week .

Patient has decreased urine output since 5 days not associated with burning micturation 
  • yellowish discolouration of urine 

No c/o - Chest pain, Palpitations , Shortness of breath ,Orthopnea, PND

No c/o - Fever , Vomitings , loose stools.

PAST HISTORY

Not K/N/C- Hypertension, Epilepsy, Thyroid disorders.

PERSONAL HISTORY
Mixed diet, decreased appetite,constipation  decreased urinary frequency.
K/C/O - Chronic Alcoholic since 20 yrs , every day consumption around 360 ml 
Last consumption 1 week back.

GENERAL EXAMINATION

Patient was conscious ,non-coherent , cooperative ,well built and nourished not so well oriented to time place & person at the time of presentation.

Pallor- present

Icterus-present

Cyanosis-absent 

Clubbing-present 

Lymphadenopathy-absent

Edema -present b/l pitting type .


VITALS

Temperature-97.6'f 

Pulse rate -90bpm.

Bp-150/80mm hg 

RR-17cpm 

Spo2-99% . 

grbs-110mg/

                  

Abdomen examination 

INSPECTION:-

Shape of abdomen -distended 

Umbilicus-inverted.

No scars ,sinuses,straie

No visible pulsations & visible peristalsis.

Moments of all 4quadrants moving equally with respiration


        Abdominal Distension

      




        

    
       
                        

                          Ecchymosis on Left shoulder
     





                              Icterus present
          

                            Bilateral Pitting Oedema
          






Percussion:-

Shifting dullness-+

No signs of fluid thrill.


CVS:-

S1,S2heard ,no murmurs.


CNS :-

Higher motor functions - intact

Cranial nerves - intact

 Sensory system - intact

Cerebellar functions are normal

Respiratory examination:- 

Trachea is central 

Chest moments -normal 

Bae-+


Investigation
09.06.2023 - 10.06.2023












11.06.2023



    




                        U.S.G impressions

ECG



Chest X-ray





12.06.2023







13.06.2023



Ascitic Fluid
Volume-3ml
Colour-clear
Rbc-nil
Tc-50
Dc-100
Others nil

ENDOSCOPY FINDINGS:

Esophagus : Grade -1 Esophageal varices (2 columns)
Stomach : Severe PHG ( portal hypertension gastropathy)
Duodenum: D1 D2 normal
Impression : Severe PHG with Grade -1 Esophageal varices 



PROVISIONAL DIAGNOSIS:

DECOMPENSATED CHRONIC LIVER DISEASE WITH PORTAL HYPERTENSION  (SPLENOMEGALY,MODERATE ASCITIS) WITH THROMBOCYTOPENIA SECONDARY TO CLD ? B12 DEFICIENCY WITH ALCOHOL WITHDRAWAL STATE.


Treatment 

Fluid restriction <2l /day 

Injection - vitk IV/ OD ( 1Amp in 100 ml NS)

CAP-evion 400mg PO/OD

Tab- Benfothiamine 100mg PO/ TID 

Tab UDILIV 300mg PO/BD 

Tab Lorazepam 2mg 1-1-2

Tab Baclofen 20mg OD(HS)

Tab Aldactone 50mg  OD 2pm

Syrup-lactulose 15ml / PO/ BD  

Salt restriction <2l/day 

Protein rich diet (2egg white/day)

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