5 . Ascites

  A 35 yrs female ,came to OPD with complaints of swelling in abdomen since 15 days. 

History of present illness:

 

Patient was apparently asymptomatic 15 days  back .

She developed fever which is mild onset ,gradually prognosive associated with chills and rigor.

patient has suffered from loss of appetite from 10 days .

Past history:

No history of chest pain ,Hypertension palpitations,cold ,cough 

no history of diabetes,epilepsy,TB,tyroid disorder.

   Personal history:

Diet-mixed

Appetite-loss of appetite 

Bowel and bladder-irregular 

Sleep-normal 

Addictions none 

Family history:

No history of DM/HTN/TB/ asthma/ thyroid 

No similar complaints in the family previously 

General examination:

-Patient is conscious,coherent,and cooperative  

No pallor or cyanosis Or icterus or clubbing 

No lymphadenopathy 

Malnutrition is observed , 

No Dehydration or odema 

Vitals:

Temp -99.5 C/F

Pulse rate -112/min 

Resp ratec-18/min

Bp-180/60 

Spo2-99%

Systemic examination:

1.cvs-inspection-chest wall is bilateral systemically 

Palpation -normal 

Auscultation-normal with regular heart beat

S1 S2 heard

No murmurs 

2.respiratory system:

Position of trachea-central,normal bilateral air entry,no Av sound 

Dyspnea is seen ,expiratory wheeze is position in all area 

Breath sound is vascular 

3.abdomen:

  GI tract /mesentery /peritoneal cavity:

-Large lobulated ascites causing peripheral displacement large bowel loops,free ascites

-mild free ascites 

significant omental thickening

Mesentric and anterior diaphymatic lymphadenopathy

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4.CNS:

Patient is conscious,

Speech is normal 

Neck stiffness is not seen 

Investigation:

Provisional diagnosis:

Chronic liver disease 

Treatment:

1.salt restriction <2.4gms/day

2.fluid restrictions <1l/day

 3. Tab. Aldacrone 50mg /PD/ OD

4. Daily body wt - Abdominal girth measurement 

5. Strict I/o charting 

6. Inj .Neomol 1 gm / IV/ If temp > 101.1 F 

7. Tab . Lasix 40mg /BD

Questions: 

How do you examine a patient with ascites? 

How much amount of fluid in ascites should be accumulated to be clinically detected ? 

 What are the complications of ascites ?

How is peritonitis diagnosed in patient with ascites?