Pt.is suffering from Ascites. Plz doctors suggest your valuable treatment. Thank you my seniors

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GOOD EVENING DR. KHAN SAHIB. NOW WE WILL START WITH YOUR QUESTION. ASCITES IS BASICALLY COLLECTION OF FLUID IN THE PERITONEAL CAVITY. FLUID THRILL WILL BE POSITIVE AND IT'S A SIGN OF MOSTLY INCREASED PORTAL HYPERTENSION DUE TO LIVER DISEASE. FLUID IS RICH IN PROTEINS.... FIND OUT THE CAUSE UNDERLYING THAT IS GO FOR LFT AND HEPATITIS MARKERS. IT MAY BE DUE TO HEPATITIS OR CIRRHOSIS.... TREAT THE CAUSE AND TAPPING IS DONE TO DRAIN THE FLUID FROM THE CAVITY.... ALCOHOL HEPATITIS MAY BE ONE OF THE REASONS.... START WITH LIPOTROPIC FACTORS LIKE METHIONINE, ISOLEUCINE, LYSIN AND VALINE, ARGININE AND IF HEPATITIS IS THERE WE WILL START WITH INTERFERONS.... FLUID INTAKE SHOULD BE RESTRICTED........ THE AIM IS TO BOTH REDUCE SODIUM INTAKE AND INCREASE IT'S RENAL EXCRETION AND BY DOING SO PRODUCE A NET REABSORPTION OF FLUID FROM THE ASCITES BACK INTO CIRCULATING VOLUME. THE MAXIMUM RATE AT WHICH ASCITES CAN BE MOBILISED IS 500 - 700 ML IN 24 HOURS. CHECK SERUM ELECTROLYTES AND CREATININE AT THE START AND EVERY OTHER DAY. WEIGH PATIENT AND MEASURE URINARY OUT PUT DAILY. DIETARY RESTRICTIONS OF SODIUM TO 40 MMOL IN 24 HRS. NOTE THAT DIURETIC OF FIRST CHOICE IS THE ALDOSTERONE ANTAGONIST SPIRONOLACTONE STARTING AT 100 MG DAILY. NOTE THAT IT'S CHRONIC ADMINISTRATION CAUSES GYNAECOMASTIA,,,, AMILORIDE 5-15 MG DAILY THEN YOU CAN SUBSTITUTE. PARACENTESIS TO RELIEVE TENSE ASCITES. SHUNTS:- THE INTRODUCTION OF PERITONEO-VENOUS SHUNT -A CATHETER FROM THE PERITONEAL CAVITY ,,, SUBCUTANEOULY., TO THE INTERNAL JUGULAR VEIN,,,, INCORPORATING A ONE- WAY VALVE -ALLOWS PASSAGE OF THE ASCITES DIRECTLY INTO THE CIRCULATION.... BUT LET ME ADD THAT TUBE OFTEN BLOCKS AND MOST CENTRES HAVE ABANDONED IT'S USE. A TRANSJUGULAR INTERAHEPATIC PORTOCAVAL SHUNT ( TIPS) IS USEFUL FOR RESISTANT ASCITES PROVIDING THERE IS INACTIVE CIRRHOSIS AND MINIMAL DISTURBANCE OF RENAL FUNCTION.... THANKS DOCTOR......
SHIFTING DULLNESS, I FORGOT TO MENTION.......
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Jalodhari vati Arogyavardhani vati Avipittikar churna Dasmulpanchkoadi kashaya
Virechan Jalodharari vati Aviltoladi bhasam Dasmulpanchkoladi kashyam
Vardhamana pippali yoga Punarnavasava Gandharvahastadi K. S
Tab arogyavardhini 2tab thrice
Shukriya dr.saab Thanks a lot