Presentation of History. DR.H.N.SARKER MBBS,FCPS,MACP(USA) MRCP(LONDON) ASSOCIATE PROFESSOR MEDICINE. Presentation of History.
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1) gradual swelling of abdomen for 3 months.
According to the patient’s statement he was reasonably well 3 months back. Then he noticed swelling of the abdomen which increases gradually over the 3 months. The swelling is associated with little discomfort, especially after meal but no pain.
The abdominal swelling is not associated with swelling of the legs, face and he is not breathlessness, no vomiting of blood and passage of tarry coloured stool.
The pt gives no history of weight loss, fever, chest pain, palpitation but noticed change of sleep pattern.
The pt. has no past history of tuberculosis or contact with known tuberculous patient and ingestion of raw milk. He has no history of heart disease, hypertension, renal disease but he suffered from viral hepatitis 7 yrs back but he does not know viral status.
He is living with his wife and one son and two daughters, all of them are healthy. No family history of liver disease, colonic carcinoma and heart disease.
The patient is not taking any medication- prescribed or non-prescribed. No history of allergy to any drug.
He is a farmer and his monthly income is 5000 tk per month living in a kacha house but using sanitary latrine and drinking tube well water.
He is non-smoker and non-alcoholic.
No history of extra marital sexual exposure.
He is not HBV vaccinated.
General examination reveals that the patient is ill-looking having hepatic facies. There is no anaemia, jaundice, cyanosis, clubbing, koilonychias, leuconychia, palmar erythema, Depuytrens contracture but he has 4-5 spider navi in the upper chest.
He has no gynaecomastia, dependent oedema. His pulse is 80 beats per minute, BP-130/80 mm of hg, Resp. rate-20/min. He is afebrile.
Alimentary system- on inspection the abdomen is distended, flanks are full, umbilicus is everted and centrally placed.
There is no engorged vein. On deep palpation, liver is not palpable.
spleen is palpable 5 cm from the anterior axillary line along its long axis, surface is smooth, firm in consistency, nontender, notch is present, insinuation test is negative.
There is ascites as evidenced by shifting dullness but fluid thrill is absent.
Normal bowel sound on auscultaion.
So my provisional diagnosis is Chronic liver disease.