Ascitis and extra pulmonary tuberculous

 A 47 year old patient,House wife by Occupation,Resident of Nalgonda,Came to OPD with cheif complaints of

Generalized itching since 1 month.

Difficulty in breathing since 7 days.

Back pain since 7 days.

HOPI:

Patient was apparently asymptomatic 6 years back then she developed giddiness for which  she went to Hospital and diagnosed as diabetes and she was on regular medication.

In March 2022 there is a history of edema in both lower limbs up to thighs ? for which she went to hospital in Nalgonda and was discharged after resolving edema? also in her tests she was  found to be having Hypothyroidism and Hypertension and she was started on regular medication.

In April 2022 she was having Abdominal Distension,She diagnosed as Ascitics for which ascitic tap was done .At that time on further examination she was found to be have cervival lymphadenopathy.

In June,FNAC was done? and found to be have extra pulmonary tuberculosis.

She is on ATT from 21 july.

H/o generalized itching  since 1 month?

H/o Shortness of breath  since 1 week which is insidious in onset Grade 4,Not associated with orthopnea,PND,chest pain.?

H/o Back pain which is continuous,non radiating.

PAST HISTORY: 

She is known case of diabetes since  6 year Hypertension  hypothyroidism since 5 month. and tuberculosi?s.

No H/o epilepsy ,CAD.

PERSONAL HISTORY:

Diet - Mixed

Appetite -Normal

Bowel and bladder -Regular. 

Sleep - adequate.

Addiction :No


FAMILY HISTORY:

Mother is known case of Diabetic.

Clinical Pictures:








General Examination:

Patient is conscious ,coherent ,cooperative

She is moderately built and nourished.

Pallor - present

Icterus - Absent

Cyanosis - Absent 

Clubbing - present

lymphadenopathy - absent

Pedal edema -present(bilateral pedal edema pitting type).


Vitals : on the day of admission


Temperature - Afebrile

Pulse rate - 97 bpm

Respiratory rate - 19 cpm

BP- 130/70 mmHg.

GRBS - 445mg/dl

Systemic Examination:

CVS: S1,S2+ heard

R/S: BAE present and Clear;

P/A : Soft, non tender,Distended,Shifting dullness present and fluid thrill absent.

CNS: intact.

INVESTIGATIONS:









USG:



Investigations on 30-08-22








Investigation on 31-08-22.




FNAC report:


Biopsy report:


Diagnosis:Ascitis secondary to Extra Pulmonary TB. 
TREATMENT:
1. TAB. LASIX 40MG/PO/BD.
2. TAB. TELMA 40 MG/PO/OD.
3. TAB. METOLAZONE 10MG/PO/BD.
4. TAB. OROFER XT /PO/OD.
5. TAB. THYRONORM 100mcg/PO/OD.
6. CAP. BIO D3/PO/ONCE WEEKLY.
7. INJ. HUMAN ACTRAPID INSULIN/ ACCORDING TO GRBS/TID.
8. TAB. RIFAMPICIN 150MG
9. TAB. ISONIAZID 75MG
10. TAB. PYRAZINAMIDE 400MG
11. TAB. ETHAMBUTOL 275MG
12. GRBS MONITORING.
13. VITAL AND TEMP CHARTING 4TH HOURLY.

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