Concluded Case

MASSIVE ASCITES Č CLP

A 75 years old male patient, complaining č pain abdo, he feels difficulty in mituration č paraphimosis, loss of appetite, afebrile č CGW, DM, sugar level is too high 458mg/ dl USg show massive ascites, O/E BP 160/90 mmHg RR 18bpm Pulse 98bpm spo2 88% CVS s1 & s2 P please suggest.....respected doctors...

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Concluded answer
Cirrhosis liver Hepatitis B infection is the cause of cirrhosis , or a comorbidity. Complicated by uncontrolled DM Difficulty in micturition is because of low urine formation due to cirrhosis " paraphimisis " is because of anasarca. Tretment of cirrhosis with diuretics ,both loop and spiranalactone, albumin infusion, salt and fluid restriction, bowel wash, PPI, oral nonabsorbable antibiotics for gut sterilisation. Liver transplant will be needed, but difficult in this age. Assessment Hepatitis B infection and tretment . Tight control of DM with insulin
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Cirrhosis liver Hepatitis B infection is the cause of cirrhosis , or a comorbidity. Complicated by uncontrolled DM Difficulty in micturition is because of low urine formation due to cirrhosis " paraphimisis " is because of anasarca. Tretment of cirrhosis with diuretics ,both loop and spiranalactone, albumin infusion, salt and fluid restriction, bowel wash, PPI, oral nonabsorbable antibiotics for gut sterilisation. Liver transplant will be needed, but difficult in this age. Assessment Hepatitis B infection and tretment . Tight control of DM with insulin
Thank you doctor
0
Liver etilogy need ro be evaluated completely. Cect whole abdomen if kft normal . Lft cbc kft pt inr Diagnostics and therapeutic ascitic tapping . Albumin infussion cover. Treat with dytor and aldactone . Strict fluid charting. Insulin as per sliding scale and lantus . As lockdown is there treat symptomatic and refer.
Thank you doctor
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the drug of choice in this case is 'yakrith pippali yoga' 500 mg thrice daily before food; 'arogyavardhini vati' 2 bd with 'rohitakarishtam' 20 ml with equal water for 40 days and then review the patient's condition. 'Nitya virechanam' with 'avipattikara curna' is advisable. plan for 'raktha mokshanam' in the left hand cubital vein for faster relief.

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