33 year old male came to the casuality with chief complaints of :

Abdominal distension since 2 months

B/L pedal edema since 2 months

Scrotal swelling since 2 months 


HOPI : 

33 year old male got married 9 years back , separated from his wife and children since 5 years due to family issues . 

After separation with his wife  ,patient started taking half a bottle of whisky every day .


3 years back he had history of abdominal distension and pedal edema for which he visited local hospital and was diagnosed as liver disease and  used medication for a while and stopped  , he was diagnosed as diabetic back then and on treatment metformin 500 mg .


8 months back :

He had abdominal distension and yellowish of eyes and used herbal medication - he did not get any relief for it , his symptoms got aggravated then he visited other hospital with abdominal distension and SOB at rest , back then he was diagnosed as DCMP secondary to alcoholism with Chronic Liver Disease with Alcohol Dependence Syndrome with DM - 2 

Patient stopped taking medication since 2 months followed by pedal edema which was insidious in onset and gradually progressive till the scrotum and abdominal distension till the xiphisternum .


Past history : 

He's a k/c/o DM -2 since 2 years and under treatment of Tab Metformin 500 mg 

K/c/o HFrEF since 6 months   , Chronic liver disease since 3 years 


Last alcohol intake 6 days ago (quantity - 1 quarter )


Not a k/c/o tuberculosis , asthma ,epilepsy .


Personal history : 

Occupation - sells plants 

Diet - mixed 

Appetite - decreased since 5-6 days 

Sleep - decreased quality of sleep due to pain 

Bowel and bladder habits - regular 

Addictions  : smoking since 10 years 

Alcohol since  10 years


Family history : no significant family history 


General examination : 



 Mild icterus present 



Edema of feet - present 



Scrotal swelling + abdominal distension 

No H/O pallor , cyanosis , lymphadenopathy


Vitals : 

Temp - febrile (99.2 degree Fahrenheit)

PR - 112 bpm

RR - 22 cpm

BP - 110/70 mmHg 

SPO2 - 99 % at RA

GRBS - 175 mg/dl 


Systemic examination : 

CVS : 

S1 S2 + 

JVP - elevated 

No parasternal heave /thrills 

Apex beat - 5th ICS 


RS :

BAE + , NVBS heard 


P/A : 

Abdomen - distended 




Normal hernial orifices 

Fluid thrill + 

Dilated  veins present 




No tenderness 

No palpable mass 

No organomegaly 

No bruit hear


CNS - no focal neurological deficit present 


Diagnosis : 

HFrEF with Chronic Liver Disease with DM type -2 


Investigations : 


Hemogram :

HB - 13

TLC - 12,100

N/L/E/M - 67 /20/10/3

PCV - 37.8

PLt - 3.13

RBC - 4.81 


RFT :

Urea - 31 

Creatinine - 0.7

Uric acid - 2.7

Calcium - 10 

Phosphorous - 3.8

Sodium - 130 

Potassium - 3.6

Chloride - 91 


LFT : 

TB - 7.26 

DB -4.21

AST - 26 

ALT - 17 

ALP - 560 

TP - 6.6 

Albumin - 3.6 

A/G ratio - 0.24 


Ultrasound : 

1.altered echotexture of liver with mild surface irregularity ?chronic liver disease 

2.Raised echogenicity of B/L kidneys 

3.Gall bladder wall edema 

4.Gross ascites

5.Skin and subcutaneous tissue shows edematous changes in the anterior abdominal wall diffusely 



Chest x-ray pa view 




ECG 





Treatment : 

1.fluid restriction <1.5 l /day 

2.salt restriction <2.4 g/day

3.Tab Lasix 40 mg po/bd 

4.Tab Aldactone 50 mg po od 

5.Tab Met xl 12.5 mg po bd 

6.Tab Thiamine 100 mg po bd

7.daily weight and abdominal girth monitoring 

8.I/O charting 

9.Monitor vitals -4th hourly

10.Grbs - 6th hourly 

11.inj HAI s/c according to sliding scale

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