Presented by 3rd Semester 2015 batch MBBS Swadha Pandey:
* 20-30 episodes of loose stool
Blood pressure-normal
A 60 year old woman presented with the chief complaint of:
* 20-30 episodes of loose stool
She presented with passage of loose stool 20 to 30 times a day
for around 3 days, with associated
problems of :
-vomiting
-abdominal distention
-swelling of feet
For the past 1 year she had episodic collection of fluid
in abdomen and swelling in limbs.
(Facilitator:
How did she know it was fluid?)
Also around a year ago she met with a motorcycle accident and
injured her sacral region.
Has type 2 diabetes mellitus for the past 3-4 years.
Non insulin taker
Blood pressure-normal
TB, asthma, epilepsy, thyroid - negative
Surgical history - for contraception
Deit-vegetarian, loss in appetite since increased passage
of stool
Sleep-adequate, reduces when abdomin is distended
Bowel and bladder- increased passage of loose stool and
decreased urine output
Allergy-unknown
Addiction- nothing
Blood transfusion- not done previously, but when admitted blood
was transfused
OBJECTIVE findings :
Abdominal distension: On clinical testing for free fluid (percussion-shifting dullness) ascites present
Bi pedal edema
Blood Investigations:
RBC- 2.14
Hb- 6.1
WBC TC-10900
Platelat count-1lakh
Serum K+- 5.1
Serum Na+-133
Urea-69
S. Creatine - 2.0
IRON STUDY :
Serum iron-16
Serum Tibc-281
Transferrin saturation-5.7
Serum ferritin-128.7
LIVER FUNCTION TEST:
Bilirubin
Total - 0.7
Indirect-0.4
Direct-0.3
Total - 0.7
Indirect-0.4
Direct-0.3
Total protein-6.5
Total globulin - 4.3
A/G ratio-0.5
AST/SGOT-69
ALT/SGPT-55
GGT-91
Alkaline phosphatase-162
Albumin-2.2
SEROLOGICAL TEST:
Anti-HCV- positive (+)
ASCTIC FLUID:
Fluid for sugar - 241mg/dl
Fluid for protein - 1.1g/dl
(Fac: Was this fluid for total protein or albumin? What about
the SAAG?)
Fluid for ADA-12.6 U/L
Fluid for LDH-84U/L
(Fac: Why was ascitc fluid for LDH done? We generally do it only
for pleural fluid).
Total leukocyte count-
Total nucleated cell-1000 cells per cumm
Nuetrophiles-80%
Lymphocytes - 20%
Total nucleated cell-1000 cells per cumm
Nuetrophiles-80%
Lymphocytes - 20%
RBC-present
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