A 29 year old Female , came to the opd with complaints of abdominal distention since 10days
Patient was born out of a second degree consanguineous marriage. She has 2 elder sisters.
At 4 years of age she had jaundice for which she was given ayuvedic medications.
She had recurrent episodes of jaundice for 3 years for which she kept consuming Ayurveda medications. She also experienced high coloured urine back then.
She studied till her inter second year. She attained menarche at the age of 15 years. She gets regular menstrual cycles every 30 days lasting for 3 days. She changes around 2 to 3 pads per day.
She got married in november 2020
In January 2021 - she experienced increased frequency of urine for which the patient visited a hospital where
her RBS was 500mg/dl. She was even found to have pancytopenia - her Hb was 6.9 g/dl, TLC - 3000/cumm, Platelets- 69,000 cells/cumm.
They were advised admission but the patient wasn't willing. 1 PRBC transfusion was done.
In month of may, she was found out to be pregnant and confirmed with UPT test
Also during her pregnancy she was started on inj Human Insulin mixtard 22 units morning and 16 units at night
In june - She developed rashes on her bilateral upper limbs and lower limbs and also had abdominal pain and bleeding PV
She had an abortion on june 30th during her second month of gestation.
She also started experiencing multiple joint pains involving bilateral MCP, PIP along with swelling and morning stiffness.
She was started onTab Wysolone 5mg OD, Tab Naproxen 500mg OD.
Tab wysolone was increased to 10mg OD and Hydroxychloroquine 200mg OD was started.
In August- Her ANA profile was done and it came negative for cardiolipin and beta 2 glycoprotein antibodies came positive.
She continued using Tab Wysolone 20mg
Since 5 days she has been complaining of Abdominal distension since 5 days which has progressed. Not associated with dyspnea, reduced urine output, pedal edema.
She also tells that she has lost weight over the past 2 months.
On examination
She is a thin built woman with pallor
PR - 87 bpm
Bp - 90/70 in left arm
110/60 in right arm
Respiratory Rate- 18 cpm
Spo2 - maintaining 98% on Room air
Temp - 98.6 F
Grbs - 387 mg/dl
Per Abdomen -
Distended
Umbilicus everted
Shifting dullness +
Bowel sounds +
You can also notice plaster after ascitic tap
Lungs - BAE +
Clear
Cns - NAD
Hb - 8.3 g/dl
TLC - 4000 cells/cumm
Platelet - 1 L/cumm
Cue shows sugar +++
LFT -
Tb - 1.17
Db - 0.39
Ast -28
Alt - 35
Alp - 434
Albumin - 2.9
TP - 5.4
Hemogram -
DIAGNOSIS:
Chronic liver disease
Hyperglycemia - known case Type 1 DM
? APLA
TREATMENT: 11AM
1. fluid restriction <1L/day
2.salt restriction<2gm/day
3.Tab.LASILACTONE (20/50mg)/po/BD
8AM -4PM
4.Tab. WYSOLONE 20mg/OD
8AM
5.Tab.Pantop 40mg po/OD
8AM
6.INJ. HUMAN INSULIN MIXTARD
22units mrng 8 AM
16units night 8PM
7.GRBS charging 6th hourly
8AM - 2 PM- 8PM- 2AM.
8.Daily abdominal girth measurement and weight.
9. Monitor vitals.
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