A female with Massive Ascites

A 6 month/mch.. k/c/o congenital hypothyroidism and operated for biliary atresia before 3 months.. with complaining of -gradual abdominal distension since 15 days -continuous fever since 15 days -yellowish discolouration of skin -irritability -bilateral pedal edema no urine or stool problem spo2-95% pr-131/min -all investigations are attached plz suggest dx and rx

38year old presented with abdominal distension and pedal edema since y months,patient smoker and occupational alcoholic.....

39yrs Female pt...Admitted with C/O Abdominal distension(Tensed,diffuse tenderness,Fluid thrill +),low grade fever×3months,B/L pedal edema,decreased lt sided vbs.Contact h/o TB present.Dx please Sir@Dr. Syam Sundar Patro

45 year old male patient chronic alcoholic and anti-HCV positive with significant HCV RNA viral load along with mild ascites 100ml on USG and mild pedal edema, no cirrhosis on USG was put on combination of sofosbuvir 400mg and Daclatasvir 60mg OD for 3 months somewhere else. He had completed 2months of treatment and stopped it. Today, he presented to OPD with C/O decreased urine output, decreased appetite, abdominal distension and breathlessness, altered stool consistency. On examination - Fluid thrill + , shifting dullness + BP - 100/60 Pulse - 130/min SpO2 - 97% Pedal edema - absent Scleral icterus - absent He states that when the lockdown got over few weeks back, he had alcohol for 4 days straight after which he has developed abdominal distension like this. Upon ascitic tap, approximate 4litres of ascitic fluid was drained. My concerns are - 1) How to proceed regarding his Hep C? HCV RNA test is quite expensive for him. Should the treatment be restarted again? 2) Regarding Salt and Water, what would be the approximate allowed amount he can take in a day? 3) Regarding selective beta blocker, Carvedilol 3.125 to be added only upon confirmation of portal hypertension on USG W/A? 4) What is the dietary advice for such patient? Proteinex Powder? 5) Regarding diuretic, he was on combination of furosemide 20mg + Spironolactone 50mg combination, is it indicated as per his condition to shift him on plain spironolactone 25 or 50mg? 6) Role of rifaximin 550mg in this case? I usually use 550mg TDS for 14 days. Thank you for your patience. You have finished the case yayy. Hurray!

A male aged 45 years *Chief Complaints* Gradually Increasing Abdominal Distension B/L Pedal Edema DOE(++) (x 2 months) *Physical Examination* P/A- Free fluid(++)