22yr male with pain abdomen and recurrent ascites

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Case presentation:

A 22 yr old male who works in pharmacy was apparently normal 3months back ,

consumed toddy continuously for 15days after which,

 on May 10th he developed severe pain in the left hypochondric and left lumbar region which was not associated with fever/vomiting.He was taken to local rmp who gave him medications for pain.

After a week as the pain was not subsided he went to nalgonda hospital where ct scan was performed.

Ct on May 17th---

Serum amylase and lipase-

He was given medications for pain and ascitic tapping was done for ascites and treated accordingly.

H/o recurrent episodes of pain.

Pain was severe 20days back for which ct scan was performed again.

 Usg on 8th aug-

 Ct on aug 14th

Ascitic fluid amylase as on 16th aug-

Ascitic fluid ADA-

Fluid microscopy-

As the patient was not affordable he was referred to our hospital for further management and got admitted on 18th August.

There is H/o weight loss about 10kgs in last 3 months.

H/o black stools and increased frequency of stools with normal consistency.

No h/o polyuria,polydipsia.

No h/o evening rise of temperature,night sweats,chest pain, palpitations and pedal edema.

PAST HISTORY-

H/O jaundice in childhood

H/o surgery for fracture of humerus.

PERSONAL HISTORY-

Diet-mixed

Appetite-lost

Sleep-adequate

Micturition-normal

Bowel-increased frequency of stools.

Addictions-

Occasional toddy drinker.

O/E-

Pt is conscious, coherent and cooperative.

no signs of pallor,icterus, cyanosis, clubbing,koilonychia and lymphadenopathy.

vitals-

afebrile

bp-120/80mmhg

pr-82bpm

rr-17cpm

CVS-S1S2 heard

RS-BAE present,NVBS heard

P/A-distended, tenderness noted in left hypochondric and left lumbar regions

CNS-normal

INVESTIGATIONS ordered-

hemogram

serum electrolytes

lipid profile

ecg

ascitic fluid -

sent for CBNAAT,proteins,electrolytes,amylase, cytology,smear, culture.

SAAG-

2decho-

Serum creatinine-

Chest xray-

Review ultrasound-

Review scan was done here in admission which dint reveal any pancreatitis .

 Diagnosis -Hemorrhagic ascitis secondary to ? Tuberculosis / peritoneal carcinomatosis,

?Recurrent pancreatitis to r/o  pancreatic divisum and other congenital anomalies.

treatment given-

1.iv fluids NS and RL @50 ml / hr

2.high Protein diet-3 eggs /day

3.T.LASILACTONE(50/20)bd po

4.inj.TRAMADOL 50 mg in 100 ml NS iv

5.inj.OPTINEURON 1amp in 100 ml NS iv

6.BP/PR /Temp /spo2 charting

7.I/O charting hrly

8.Grbs-6th hrly

9.Neb. with asthalin 4 respules/stat

10.inj.LASIX 20 mg iv stat( if bp >120 mmhg)