Blunt abdominal trauma

A case of blunt abdominal trauma 1 yrs ago Chief Complaints Abdominal distention for 2 weeks and bilateral lower limb swelling up the level of knee History Patient came with abdominal distension which started gradual Progressively increased in severity with time being relieved by diuretic with no aggravating factor. He is also having lower limb sweling pittingvin nature and painless up tho the level of knee bilateral But prior to this the patient had a history of fall from a height while walking as a masonry.and landing on the left side of the abdomen. (Nor document about the injury) that is when he started experiencing abdominal distension. But prior to that he had no history of taking care of someone with jaundice. No history of multiple sexual partner. No history of injectinng drugs. No history of multiple transfusion No history of schistosomiasis No history of rice cultivation No history of Tb contact No history of abdominal tumor. He is Hiv negative. No prior history of being diagnosed with HEPATITIS born to HBv negative mother. Vitals Bp 100/60mmhg Pr 96 Spo2 96% Temp 36.0 Physical Examination He is cachexic The patient has no jaundice. Has no pale Conjuctiva No parotid swelling No glossitis Normal har distribution No spider angioma No gynecomaastia Normal axillary hair No dupyuterin contracture Normal thenar hypothenal muscle No koilonychia No caput meduall No testicular atrophy Libido is lost Abdomen is Distension massively Liver about 12cm length Spleen unpapable Postive fluid thrill Lower limb swollen pitting in nature ++ up to the level knee painless Investigations Investigation still not yet done. ... Diagnosis What may be probabaly cause of this And how to act?

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req. YSG abdomin, and req. other investigation and reports adv to gastroenterologist Rx Punarnavashtak qwath BD galo ghan tab 1 bd

Excellent and detailed,case history and examination findings. But as per the history of fall , it should have been a case of haemoperitoneum - but as per his detailed history , pulse and B.P near normal - it seems to be a case of ASCITIS with cirrhosis liver with portal hypertension? Patient needs further evaluation with 1.Ultrasonography abdomen 2.Ascitic fluid tap for cytology and biochemistry 3.CBC , LFT, KFT 4.X - ray chest 5.Cardiac evaluation with 2D echocardiography 6.Fibroscan

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The picture shows abdomen is distended. The skin of abdomen in shiny which indicate that the distention of abdomen is of recent onset, therefore the skin has become stretched hence there is shiny appearance of skin There are few dilated veins visible on skin typically seen in distention of abdomen because of Ascites, usually caused by portal hypertension and commonest cause being underlying cirrhosis of liver. This stage is one stage before proper caput medusae appearance seen on abdomen caused by portal hypertension. The umbilicus is shifted downwards, which indicate that there is distention in upper abdomen, once again seen in this having gross ascites. Impression Clinical picture of portal hypertension, cirrhosis of liver and ascites. Bilateral edema feet caused by hypoproteinemia seen in cirrhosis of liver and retention of sodium typically seen in cirrhosis of liver caused by excess secretion of antidiuretic hormone. Adv Sonography of abdomen Liver function test CBC Renal function test Serum electrolyte

Gross Ascites seen..Tapping and ascitic fluid ANALYSIS should be done along with CBC ,LFT and KFT

Massive ascites,fluid tapping followed by analysis.till then treat with higher antibiotics, diuretics,beta blockers, multivitamin s,IVF with 3%ns

Hyperpigmentation lesions o. Anterior abdominal wall. Ascitis noted. Adv USG abd and pelvis. Need to rule out hepatosplenomegaly And portal hypertension. Ascitic fluid analysis. Diuretics Betablokers 1 to 1.5 lit fluid tapping alt day.

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Ascites. Check Liver function / Tebal function. Taping and investigate for Koch's & Melding bench & Cirrhosis of liver.

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PT have ascitis due to cirrhosis liver/CKD Adv LFT rft USG ABDOMEM Openion gastroenterologist/nephrologist

? Ascites

Ascitis

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