38year old male with chronic liver disease

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A 38 yr old male who is a motor dweller came to op with c/o abdominal distension, loss of appetite, loose stools since 1 week 

Pt was apparently asymptomatic 1 week back then he developed distension of abdomen and flanks are full not associated with pain 

Loose stools of 5 to 6 episodes mucoid in consistency, small quantity and no  foul smelling

Feeling of complete defecation +

No history of loss of taste sensation

No H/ of pain abd , vomtings, haematemesis, bleeding gums, malena, shortness of breath , pedal edema

Past history : 

Pt had similar complaints 2years ago

H/o jaundice 2 years ago

He is a K/c/o diabetes mellitus type 2 and on medication (glimi m2)

Personal history :

Mixed diet

Decreased appetite

Decreased flow of urine

Addictions: 

Alcoholic (180 ml whisky daily since 7 years) due to divorce with his wife.

Tobacco 4-5 times per day since 8 years

Vitals :

Pt is C/C/C , moderately built and moderately nourished

Pallor present

Icterus present

Clubbing, cyanosis, lymphadenopathy,pedal edema - Absent

Afebrile

Bp : 120/80 mm hg

Pulse : 92 BPM

Resp rate : 18 cpm

Local examination :

Per abdomen : Inspection :

Shape : distended

Umbilicus :everted

Engorged veins present

No visible pulsations,no scars, no sinuses

Palpation:

Hepatomegaly is present

Liver span is 14cm

Splenomegaly is present

Percussion:

Free fluid present

Shifting dullness is present

Fluid thrill is absent

Auscultation :

Bowel sounds present

CVS :

S1,S2 heard

No murmurs

Resp system:

NVBS present ,BLAE present

CNS :

Cranial nerves intact

Sensory system intact

Motor system intact

Provisional diagnosis :

Chronic liver disease

Investigations :

Hemogram:

Prothrombin time

Blood group

Complete urine exam

LFT

Rft

ECG

USG

Treatment: 

1)Inj Thiamine 1amp in 100 ml NS IV TID

2)Inj Pantop 40 mg IV BD

3)Inj Optineuron 1amp in 100ml NS IV OD

4)Inj Norflox 400mg IV BD

5) Tab Lasilactone 20/50mg OD

6) Tab Glimi M2 OD before food

7)Syrup Hepamerz 10ml BD

Day 1:

3 episodes of stools , mucoid in consistency,non foul smelling.

On examination:

Pt is C/C/C, pallor present , icterus present

Abd girth : 83cm

Vitals :

Afebrile

Bp:120/80 mm hg

Pulse: 92bpm

Resp rate:18cpm,NVBS

CVS : S1,S2 heard

No murmurs

CNS : NAD

Investigations :

Stool for occult blood:

Treatment :

1) Inj Norflox 400mg IV BD

2) Tab Lasilactone 20/50mg PO /OD

3)Inj Optineuron 1amp in 100 ml NS IV OD

4)Inj Pantop 40 mg IV BD

5)Tab Glimi M2 OD before food

6)Tab Sporolac ds TID

Day 2:

3 episodes of stools mucoid in consistency

Vitals:

Afebrile

Bp :120/80 mm hg

Pulse:76bpm

Resp rate :18 com

CVS : S1,S2 heard, no murmurs

CNS: NAD

Investigations :

Treatment:

1)Inj Norflox 400 mg IV BD

2)Tab Lasilactone 20/50mg PO/OD

3)Inj Optineuron 1amp in 100ml NS IV OD

4)Inj Pantop 40 mg IV BD

5)Tab Glimi M2 OD before food

6)Tab Sporolac ds TID 

Day 3:

C/o 3 episodes of loose stools 

Abd girth : 82cm

Vitals:

Afebrile

Bp : 110/60 mmHg

Pulse:72 bpm

Resp rate:18cpm

Investigations :

Treatment:

1)Inj Norflox 400mg IV BD

2) Tab Lasilactone 20/50mg PO /OD

3)Inj Optineuron 1 amp in 100ml NS IV OD

4) Inj Pantop 40 mg IV BD

5)Tab Glimi M2 OD before food

Day 4 :

Treatment:

1) 2 amp of Kcl in 500 ml NS over 5hours

2) Insulin actropid according to sliding scale