Case history 2

 30 YEAR OLD FEMALE WITH ABDOMINAL DISTENSION AND BILATERAL PEDAL EDEMA. 

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A 30 year old woman presented to opd with the complaints of Abdominal distension since 4 months,

Dyspnea at rest since 4 months 

She used to work as a coolie and was married at the age of 18 years. She has given birth to 4 children, 3 daughters and one son(the youngest), all through normal vaginal delivery. Her last delivery was 20 days back and the abdominal distension which she developed during pregnancy was gradually progressive and often felt dyspneic especially onexertion. She even had bilateral lower limbs swelling extending to her knees which resolved on its own. 

On further questioning, she gave a history of non productive cough which lasted for a month prior to her son's delivery 

Obstetric history- P4L4

On examination-She is thin built

Pallor +

Vitals-

PR - 70bpm, normal in volume, regular, no radio-radial or radio femoral delivery 

Bp - 100/70mmhg

Afebrile

Spo2 - 98% on Room air

RR - 20cpm

Systemic Examination- 

Per Abdomen - 

On Inspection: 

Distended 

Umbilicus everted

Palpation-

No tenderness

No palpable organomegaly 

Percussion -

Dull note present in all areas of the abdomen

Fluid thrill present

Bowel sounds present

CVS- S1,S2+

RS- Bilateral vesicular breath sounds +

CNS - Normal

                                       Cue

               

                                            Ecg

Chest x ray

PROVISIONAL DIAGNOSIS

Ascitis can be secondary to  Intestinal TB

TREATMENT-

1.Tab.lasilactone 20/50 mg

2.Tab.pan 40 mg /OD