A young male aged 18 yrs presented with complaints of pain abdomen and generalised weakness since a month....No h/o constipation, loose stools or bleeding was present...Stool FOBT was negative but he was having sevwre pallor....Comment on the approach to this patient....

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Issues Pleural effusion + Ascites + lymoahdenopathy + Raised create Infective etiology involving multiple systems most likely eg disseminated kochs.. I would suggest Pleural and ascitic fluid diagnostic tapping , rule out exudative vs transudative fluid....do ADA, LEH ,protein and sugars... Also Do urine routine for proteinuria..other possibility of nephrotic syndrome...

If he has fever ...D/D may be leptospirosis
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Amoebic hepatitis wth pleural effusion.maybe burst abscess,or sympathetic effusion.

Amoebic abscess has been heard....wts amoebic hepatitis?
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Pleural effusion Chronic kidney disease R/o disseminated koch

PLEURAL EFFUSION

His investigation sort from raised urea and slightly raised creatinine is remarkable, his job is 11.5 so you can forget the pallor,I would like to know which area of abdomen ,the pt.has pain.to me without palpation it is very difficult to diagnose pain abdomen. I am from old school of medicine , and examination of pt.is paramount to reach a diagnosis,but you young people investigation is important.msy be that is the way you have been taught.yry put a drip of normal saline or dextrose after checking sugar .

Ckd: cause? : urinalysis culture for AFB.,if necessary Bx( cause of anemia) Cxr rt pleural effusion with hilar adenopathy: usg abdomen: mesenteeic lymphadenopathy with free fluid: diagnostic aspiration of pleural fluid & analysis: clinical picture suggest Tuberculosis.

Pain abdomen with mesenteric lymphadenopathy. Right pleural effusion. Acute kidney injury. Thrombocytopenia. DD-Typhoid. Tb. Lymphoma. Please update pleural fluid analysis Check ldh Uric acid. Tsh. B12. Widal. Plan bone marrow aspiration and biopsy

Generalised tiredness anemia - please check USG ABDOMEN AND KUB, urine RE serum creatinine sodium potassium albumin cholesterol calcium phophorous uric acid

Looks like infective etiology.....x Ray shows pleural effusion tap an see...Specifically look for ADA levels and also to look for fluid cholesterol

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