34/M with distended abdomen, hiccups and difficulty breathing

34/M Patient who was apparently well 10 days back with no problems, has come with: Abdominal distension, nausea, burping, hiccups off & on, difficulty breathing, occasional mild coughing x 10 days Chronic tobacco chewer, occassional alchol consumption H/o passing frequent scanty stools. H/o dark / blackish stool x 1 day H/o yellowish to dark yellow urine x 10 days with occasional reddish urine No h/o fever, burning micturition, bleeding from any site Patient had been prescribed AKT-4 yesterday and has taken 1 dose today morning. H/o severe headache 10 days back. Similar episode 5 years back. No details about investigations available at present. ---- GCS = 15. Vitals stable. Pallor present. No apparent icterus, edema, cyanosis, lymphadenopathy. However, GC seems poor. Chest: A/E reduced bilaterally (rt > lt). B/L crepts. Abd: Distended, mild generalized tenderness more pronounced in RUQ and epigastrium No significant findings on genital or per-rectal exam. CVS and neurological exam - no significant findings. ---- Patient has some reports from his consultation elsewhere. (Attached). Somehow I feel that the provided reports do not match the patient's condition. ---- Diagnosis, work-up and management?

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CXR..STUDY .. RT..SIDE .. PLURAL EFFUSION .. CARDIOMEGALY .. NEED'S .. FURTHER EVALUATION ..

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Can be a case of liver abscess. USG whole abdomen should be done initially the other imagining as required

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POSSIBLY RT PLEURAL. EFFUSION WITH ?? CARDIOMEGALY

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Interesting Case.. Reports noted.From report point of view looks dominant pleural effusion case. But from case history it points to else. since clinical examination diagnosis to be confirm.. My view-ptn may be cachexic-RT basal poor auscultation due to pleural effusion- since ptn is not icteric and pallor-so pigmented urine can be seen due to diet-but urinalysis may confirm. above complaints could show d/d-functional dysphagia- GERD-peptic ulcer disease to rule out. Need to understand any history of wt loss-BMI-confirmatory test for TB- sos urinalysis- stool r/m. If required can consider for endoscopy otherwise with anti TB treatment and multivitamins to continue.

Thanks for ur appreciation Dr Dinesh Gupta Sir..
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Pleural effusion right. Cardiac shadow is enlarged.

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Pt is alcoholic and tobacco chewer Symptoms are presenting GI system Malena suggest APD may be ulcer and need to subject endoscopic examination to r/o gastric malignancy Pleural effusion on rt side is secondary I suspect to gastric malignancy Pt is passing frequently scanty stools demands colonoscopy to r/o colonic malignancy Yellowish red urine is it after Akt than it is drug induced changes otherwise needs to evaluate No where any sign of tuberculosis so prescription of AKT is irrelevant Dear dr Vijay Kumar Singh in my opinion primarily he is a c/o APD need to workout

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gastroesophageal reflux,dyspepsia.plural effusion, cardiomegaly ? Adv :- ECG and CT

X-RAY SHOWS RIGHT SIDE PLEURAL EFFUSION AND HE WAS STARTED ON AKT-4 AND TODAY HE TOOK 01 DOSE. FIRST OF ALL, STOP AKT IMMEDIATELY AS IT WILL CAUSE MORE INJURY TO LIVER. DO, CBC, ESR, CRP, MT, LFT, KFT, RBS, HBA1C, URINE ROUTINE, S. AMYLASE, S. LIPASE, HIV, HBSAG, HCV, HEPATITIS A, HEPATITIS E, STOOL ROUTINE, ECG, WIDAL, TYPHIDOT, COVID-19 RT-PCR, SPUTUM FOR AFB AND CBNAAT. RX, ADMISSION IN ICU NPO RYLES TUBE INSERTION FOLEY'S CATHETERIZATION O2 BY NASAL PRONGS INJECTION PIPZO 4.5 MG IV BD INJECTION PAN-40 MG IV BD INJECTION EMSET IV TDS INJECTION DEXA 2CC IV BD INJECTION DERIPHYLLLIN IV BD SYP MUCAINE GEL 15 ML TDS SYP ARISTOZYME 10 ML TDS INJECTION POLYBION IN 100 ML NS TDS NEBULIZATION WITH DUOLIN AND BUDECORT TDS. TAB MONTICOPE OD HS IV FLUIDS:- D5% WITH MVI INFUSION RL DNS SYP LIVOLUK 30 ML HS.

THANKS @Dr. Vijay Kumar Singh SIR
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RT Pleural Effusion

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Mild cardiomegaly with pleural effusion rt.side.

Thanks,Dr.Shailesh Patel.
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