06-05-2025
THIS IS AN ONLINE E LOG BOOK TO DISCUSS OUR PATIENT'S DE-IDENTIFIED HEALTH DATA SHARED AFTER TAKING HIS SIGNED INFORMED CONSENT. HERE WE DISCUSS OUR PATIENT'S PROBLEMS THROUGH SERIES OF INPUTS FROM AVAILABLE GLOBAL ONLINE COMMUNITY EXPERTS WITH AN AIM TO SOLVE THOSE PATIENT'S CLINICAL PROBLEMS WITH COLLECTIVE CURRENT BEST EVIDNCE BASED INPUTS.
[06-05-2025 12.24] PPM 1: OPD now @PPM3: 77M twice admitted in Jan 2025 with pedal edema, hydrocele and ascites. Now complains of gynecomastia after two months of taking lasilactone with pain in the left breast!
[06-05-2025 15.05] PPM 1: Please share his chest X-ray @PPM4 @PPM5.
[09-05-2025 13.24] PPM 1: @PPM3's project patient where the previous surgery unit discharge summary initially diagnosed tubercular peritonitis but later changed to portal hypertension and started him on spironolactone that caused his gynecomastia in 3 months 👇
Age/Gender: 77 Years/Male
Address:
Discharge Type: Relieved
Admission Date: 16/01/2025 04:11 PM
Name of Treating Faculty
Diagnosis
? TB PERITONITIS
Case History and Clinical Findings
C/O SWELLING IN LEFT GROIN SINCE 1WEEK ASSOCIATED WITH PAIN
HOPI: PATIENT WAS APPARENTLY ASYMPTOMATIC 1WEEK AGO LATER HE DEVELOPED SWELLING IN THE LEFT GROIN WHICH WAS INSIDIOUS IN ONSET GRADUALLY PROGRESSIVE TO PRESENT SIZE REDUCING ON LYING DOWN POSITION, ASSOCIATED WITH DRAGGING TYPE OF PAIN NON-RADIATING INCREASES ON WALKING, SQUATTING AND CLIMBING STEPS REDUCES ON TAKING REST.
NO H/O LIFTING HEAVY WEIGHTS
NO H/O TRAUMA, CHRONIC COUGH, CONSTIPATION, LOOSE STOOLS NO H/O FEVER
NO H/O LOSS OF WEIGHT, LOSS OF APPETITE PAST ILLNESS:
NOT A KNOWN CASE OF HTN, DM, TB, ASTHMA, EPILEPSY, CAD, CVA.THYROID DISORDERS H/O RIGHT DISTAL RADIUS FRACTURE AND SURGERY DONE 4 YRS AGO
GENERAL EXAMINATION: PT IS C/C/C
AFEBRILE
BP- 110/70 MMHG PR- 78 BPM
RR- 19CPM SPO2- 99%
GRBS- 112 MG/DL
NO PALLOR, CYANOSIS, CLUBBING, ICTERUS, EDEMA, LYMPHEDENOPATHY CVS-S1S2 PRESENT, NO MURMURS
RS-BAE PRESENT, NVBS
P/A-SOFT, NON TENDER, BS PRESENT LOCAL EXAMINATION:
INSPECTION:
AN SOLITARY SWELLING OF SIZE SHAPE IS SEEN IN LEFT INGUINOSCROTAL REGION VISIBLE COUGH IMPULSE PRESENT
SKIN OVER AND AROUND THE SWELLING APPEARS TO BE NORMAL NO VISIBLE SCARS, SINUSES, ENGORGED VEINS
NO VISIBLE PULSATIONS, PERISTALSIS
PENIS IS IN MIDLINE; OPPOSITE SIDE APPEARS TO BE NORMAL PALPATION:
NO LOCAL RAISE OF TEMPERATURE TENDERNESS PRESENT
ALL INSPECTORY FINDINGS ARE CONFIRMED ON PALPATION W.R.T SIZE, SHAPE, NO EXTENT
GETTING ABOVE THE SWELLING NEGATIVE CONSISTENCY- DOUGHY
REDUCIBLE
RING OCCLUSION TEST PERCUSSION:
DULL NOTE HEARD AUSCULTATION:NO BRUIT HEARD
GENERAL MEDICINE REFFERAL DONE ON 17/1/25 I/V/O RAISED BILIRUBIM LEVELS, B/L PEDAL EDEMA, MILD ASCITES
DIAGNOSED CIRRHOSIS OF LIVER (ASCITES SECONDARY TO PORTAL HYPERTENSION?TB PERITONITIS)
ADVICED:
TAB.LASIX 20MG PO/OD
TAB. ALDACTONE 100MG PO/OD
ASCITIC FLUID FOR CELL COUNT /CELL TYPE FLUID ANALYSIS FOR CBNAAT
Investigation
RFT 16-01-2025 04:25: PM UREA 36 mg/dl 50-17 mg/dl CREATININE 0.9 mg/dl 1.3-0.8 mg/dl URIC
ACID 3.4 mmol/L 7.2-3.5 mmol/LCALCIUM 10.0 mg/dl 10.2-8.6 mg/dl PHOSPHOROUS 3.3 mg/dl 4.5-
2.5 mg/dl SODIUM 136 mmol/L 145-136 mmol/LPOTASSIUM 4.4 mmol/L. 5.1-3.5 mmol/L.CHLORIDE 101 mmol/L 98-107 mmol/L
LIVER FUNCTION TEST (LFT) 16-01-2025 04:25:PM Total Bilurubin 2.27 mg/dl 1-0 mg/dl Direct Bilurubin 0.45 mg/dl 0.2-0.0 mg/dl SGOT(AST) 47 IU/L 35-0 IU/LSGPT(ALT) 17 IU/L 45-0
IU/LALKALINE PHOSPHATASE 179 IU/L 119-56 IU/LTOTAL PROTEINS 7.0 gm/dl 8.3-6.4 gm/dl ALBUMIN 3.12 gm/dl 4.6-3.2 gm/dlA/G RATIO 0.80COMPLETE BLOOD PICTURE (CBP) 16- 01-2025 04:25:PM HAEMOGLOBIN 10.8 gm/dl 17.0-13.0 gm/dl TOTAL COUNT 6000 cells/cumm
10000-4000 cells/cumm NEUTROPHILS 45 % 80-40 %LYMPHOCYTES 43 % 40-20
%EOSINOPHILS 05 % 6-1 %MONOCYTES 07 % 10-2 %BASOPHILS 00 % 2-0 %PLATELET
COUNT 1.3SMEAR Normocytic normochromic anemia with mild thrombocytopenia
Anti HCV Antibodies - RAPID 16-01-2025 04:25:PM Non ReactiveHBsAg-RAPID 16-01-2025 04:25:PM Negative
2DECHO DONE ON 16/1/25IMPRESSION:
MILD MR+: TRIVIAL AR +/MR+;NON PAH NO RWMA, NO AS/MS.SCLEROTIC AV GOOD LV/RV SYSTOLIC FUNCTION
NO DIASTOLIC DYSFUNCTIONS NO PE/LV CLOT
USG B/L INGUINO SCROTAL REGION DONE ON 16/1/25: IMPRESSION: B/L EPIDIDYMITIS
B/L MULTIPLE, ENLARGED INGUINAL LYMPH NODES MODERATE ASCITES
B/L MILD HYDROCELE
E/O MILD-MODERAATE SUBCUTANEOUS EDEMA IN B/L INGUINAL REGIONS USG ABDOMEN DONE ON 17/1/25:
IMPRESSION: E/O SHRUNKEN LIVER WITH COARSE ECHOTEXTURE F/S/O CHRONIC LIVER DISEASE
GROSS ASCITES
NO SPLENOMEGALY
Treatment Given (Enter only Generic Name)
NORMAL DIET
TAB.MVT.PO/OD TAB.VIT-C PO/OD
TAB.UDILIV-300MG PO/BD TAB.OFLOX-OX PO/BD TAB.HIFENAC-P PO/BD
Advice at Discharge
NORMAL DIET
TAB.OFLOX-OX PO/BD X 1 WEEK TAB.PAN 40 MG PO/OD X 1 WEEK TAB.MVT.PO/OD X 1 WEEK TAB.VIT-C PO/OD X 1 WEEK
TAB.UDILIV-300MG PO/BD X 1 WEEK TAB.HIFENAC-P PO/BD X 1 WEEK TAB.LASIX 20MG PO/OD X 1 WEEK
TAB. ALDACTONE 100MG PO/OD X 1 WEEK
Follow Up
REVIEW TO GS OPD AFTER 1WEEK/SOS WITH REPORTS
When to Obtain Urgent Care
IN CASE OF ANY EMERGENCY IMMEDIATELY CONTACT YOUR CONSULTANT DOCTOR OR ATTEND EMERGENCY DEPARTMENT.
Preventive Care
AVOID SELF MEDICATION WITHOUT DOCTORS ADVICE, DONOT MISS MEDICATIONS. In case of Emergency or to speak to your treating FACULTY or For Appointments, Please Contact: For Treatment Enquiries Patient/Attendent Declaration: - The medicines prescribed and the advice regarding preventive aspects of care, when and how to obtain urgent care have been explained to me in my own language
SIGNATURE OF PATIENT /ATTENDER
SIGNATURE OF PG/INTERNEE
SIGNATURE OF ADMINISTRATOR
SIGNATURE OF FACULTY
Discharge Date Date:18/1/25 Ward:MSW Unit:IV
[09-05-2025 16.01] PPM 2: But did they treat the portal hypertension? Seems no
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