MAY 28, 2020
THIS IS AN ONLINE E LOG BOOK TO DISCUSS OUR PATIENT'S DE-IDENTIFIED HEALTH DATA SHARED AFTER TAKING HER 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 EVIDENCE BASED INPUTS.
A 29 year old female was presented to our OPD in a wheelchair with complaints of chest pain and abdominal distension since 1 month.
HISTORY OF PRESENT ILLNESS:
Patient was apparently asymptomatic one month back then she developed chest pain on the left side stabbing type non radiating since one month and abdominal distension gradual in onset progressive in nature since 1 month associated with shortness of breath grade 2 to 3
N/H/O pedal Edema, Palpitations, Orthopnea and PND
N/H/O Constipation, Nausea, Vomitings or Diarrhoea
N/H/O Fever, Weight loss, Cough
N/H/O Hematemesis, Melena, or Yellowish discoloration of eyes
PAST HISTORY:
She got married in 2015 and conceived in the month of ?May 2016.
Bleeding PV after two months of pregnancy for which she had been to hospital and was told about abortion for which Dilatation and Curratage was done.
In 2017 September she conceived again and her 1st and 2nd trimester were uneventful. EDD was in the month of June 2018.
She had been to doctor on 1st June and USG turned out be normal. Then she had been to doctor again on June 11th as she had tightening of abdomen for which USG was done and was told as IUD as there was no fetal heart rate. And then normal vaginal delivery was for bringing out IUD.
In 2019 February they had been to doctor in view of not conceiving for which she underwent investigations and her PLBS? 210 and was started on OHA. She was on OHA for 1 month.
2020 May: LMP: 17/05/2021 she conceived for 3rd time. And was again on OHA (for 20days) in the month of July and from August she was on Inj Equisilin (NPH (70)/regular (30)/sc.
And when she had been on 24th January to doctor for abdominal distension causing difficulty in sleeping and moving, she underwent USG showing Polyhydramnios. And she was operated (Cesaerean section) at 7 pm IVO fetal bradycardia. Baby cried immediately after birth.
Baby weight (boy) 3200 grams. And she was discharged on 28th January 2021. Her sugars were normal so after delivery she was not on any hypoglycemic agents.
Since March 2021 c/o left sided chest pain stabbing type with abdominal distension with loss of appetite.
Past History: Patient is a diabetic since 3 yrs.
No history of Hypertension, Tuberculosis, HIV, Malignancy, Thyroid Disorders.
Personal History: Patient takes mixed diet, bowel bladder normal.
Non alcoholic and smoker.
No significant family history.
Surgery referral was done in the view of need for peritoneal biopsy.
Advice: Plan for diagnostic laparoscopy+ proceed to peritoneal or omental biopsy.
Report: Multiple paracentesis was done with 500ml draining out each time.
IT WAS REFRACTORY ASCITES.
