62/F came to casualty with c/of pain abdomen since 1 month 
Yellowish discoloration of eyes since 15 days 
Vomitings since 15 days
sob since 15 days 
Decreased appetite since 15 days
Patient was apparently asymptomatic 1 month back 
Had H/of pain abdomen on and off since 1 month - insidious onset, intermittent , diffuse and burning type of pain associated with decreased appetite taking only fluids since 15 days f/by vomitings - bilious, non- projectile, food or water as content whenever patient is taking oral feeds
Yellowish discoloration of eyes since 15 days 
Sob since 15 days inscidious onset gradually progressed from grade 2 to 3 associated with pedal odema and decrease urine output 
not associated with fever, cold, cough, orthopnea and PND
No pale coloured stools, mucous , blood or dark coloured stools 
0/examination: pt-conscious and tachypnic 
Afebrile 
Icterus + 
No pallor, cyanosis, clubbing, lymphadenopathy
PR - 90 bpm 
BP- 130/80 mm of hg 
RR - 34 cpm 
Spo2 -88 with RA 
98 with 2 L of oxygen
GRBS : 85 mg /dl
R/S : fine crepts + in B/L IAA ,ISA 
Decreased breath sounds in right IAA and ISA 

CVS - S1 and S2+
P/A - soft, tenderness + in epigastric region , right hypochondrium and umbilical region 
R/S : fine crepts + in B/L IAA ,ISA 
Decreased breath sounds in right IAA and ISA 

CVS - S1 and S2+ 
CNS - NAD

INVESTIGATIONS
Abg:
Usg abdomen
Cxr

X ray erect abdomen

Pleural fluid

Ascitic fluid
MRCP :
Pleural fluid:
 sugar:56
Proteins:3.7
LDH :409
Albumin:2.2
Amylase 8.7

Ascitic fluid:
sugar:49
Proteins:3.8
LDH :605
Albumin:2.2
Amylase 23
Saag :0.2
CT abdomen:
Referrals:
Surgery referal
gastroenterology referal
Ent referal

Diagnosis:
Obstructive jaundice secondary to CBD stricture/cholangio carcinoma

Popular posts from this blog

Image
54 YEAR OLD MALE PATIENT WITH DISTENTION OF ABDOMEN, JAUNDICE, BURNING MICTURITION SINCE 15 DAYS   This is an online E Logbook to discuss our patient's de-identified health data shared after taking his/her guardian's signed informed consent. Here, we discuss our individual patient's problems through a series of inputs from an available global online community of experts to solve those patients' clinical problems with collective current best evidence-based inputs. This e-log book also reflects my patient-centered online learning portfolio and your valuable inputs in the comment box are welcome. —————————————————————————————————————————————- A 54 YEAR OLD MALE  PATIENT CAME WITH COMPLAINTS OF  1. DISTENSION OF ABDOMEN SINCE 15 DAYS 2. H/O JAUNDICE SINCE 15 DAYS 3.BURNING MICTURITION SINCE 15 DAYS NO H/O FEVER,SOB,PEDAL EDEMA HOPI:  PATIENT WAS APPARENTLY ASYMPTOMATIC 5 MONTHS BACK, ON JAN 2021 PATIENT WAS OPERATED FOR GALL STONES.POST OP NO COMPLICATIONS AND WAS NORMAL .
Read more
Image
 A 35 year old man presented to the casualty with the complaints of  Bilateral pedal edema since 1 week Dyspnea since 15 days  Abdominal distension since 2 months  History of Presenting illness A 35 year old man, who sells plants  at nalgonda tells us a detailed insight to the reason for all his problems. He says he has been married 9 years back but since the past 5 years he has been living apart from his wife and his 2 sons due to marital issues. Prior to that he used to consume alcohol occasionally but since the past 5 years he has been consuming about half to 1 bottle of whiskey everyday. 3 years back, he paid a visit to a local hospital with abdominal distension and pedal edema and he was diagnosed with chronic liver disease for which he used medications for a while and stopped. He was even diagnosed to be a diabetic back then and he started using Tab Metformin 500mg OD. 2 months back, his abdominal distension increased and his eyes became yellow after which he started using local
Read more