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ABD CASE 1

A 65-year-old female with a history of asthma presents with bilateral lower limb swelling, breathlessness, easy fatiguability, significant weight loss, and a recent blood transfusion, suggesting anemia and possible cardiac failure. Physical examination reveals severe pallor, bilateral pitting edema, and hepatosplenomegaly. Differential diagnosis includes malignancy.

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Ram Pradeep
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17 views16 pages

ABD CASE 1

A 65-year-old female with a history of asthma presents with bilateral lower limb swelling, breathlessness, easy fatiguability, significant weight loss, and a recent blood transfusion, suggesting anemia and possible cardiac failure. Physical examination reveals severe pallor, bilateral pitting edema, and hepatosplenomegaly. Differential diagnosis includes malignancy.

Uploaded by

Ram Pradeep
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© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PPTX, PDF, TXT or read online on Scribd
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ABDOMEN CASE 1

HEPATOSPLENOMEGALY

DR.MOUNIKA REDDY.V
PROF.DR.SOWMYA.G PROF.DR.GANESH
FINAL YEAR PG
DEPT OF GENERAL MEDICINE HOCS of MGE
GENERAL MEDICINE
SRMC SRMC.
SRMC
CHIEF COMPLAINTS

• 65 year old female , home maker , residing at Avadi came with complaints
of
• Bilateral lower limb swelling for 1 month
• Breathlessness for 1 month
• Easy fatiguability for 1 month
HOPI
• H/o bilateral lower limb swelling for 1 month , insidious onset , gradually
progressive, upto middle of the leg , not associated with pain/ redness, no
diurnal variation , no aggravating/ relieving factors .
• H/o facial puffiness for the past one month , more in the morning after
waking up from sleep , subsides as the day progresses.
• H/o breathlessness on exertion for the past 1 month , NYHA grade II , not
associated with chest pain/ orthopnea/PND. No aggravating/relieving
factors.
• H/o palpitations for the past 1 month on and off, regular and occurs on
exertion and relieved with rest.
• H/o generalised tiredness and easy fatiguability +
• H/o loss of appetite +
HOPI

• H/o significant loss of weight+(57kg to 43.5 in 7 months period)


• H/o low grade fever for 2 days one month back
• H/o chronic dry cough present,seasonal variation present, no diurnal
variation.
• No h/o hemoptysis.
• No h/o frothy urine or reduced urine output.
• No h/o abdominal pain/distension/early satiety/bloating.
• No h/o malaena, haematochezia, haemetemesis and other bleeding
manifestations.
PAST HISTORY

• Patient had a history of giddiness and fall 6 months back (not associated with LOC,
seizures) along with breathlessness and bilateral lower limb swelling for which she
underwent treatment at a private hospital where she was transfused 3 units of
blood
• Patient was advised bone marrow study but returned home as she was unwilling for
the same.
• Patient was symptom free until current presentation.
• Patient is a k/c/o bronchial asthma for > 30 years , uses inhaler therapy during
exacerbations twice a week.
• No other known comorbidities.
• No h/o native or other medications before illness.
Personal history

• Takes mixed diet


• Does not consume alcohol / tobacco .
• Regular bowel and bladder habits.
• Difficulty in sleeping at night for the past 1 year after the death of her
husband.
• No contact with a known TB patient.
• Attained menopause at the age of 50.
SUMMARY

• 65 year old female , a known asthmatic , presented with bilateral pedal


edema , exertional dyspnea(NYHA class I to III), easy fatiguability with
significant loss of weight and loss of appetite and history of blood
transfusion 6 months back- suggestive of anemia in cardiac failure.
• Differential diagnosis:
malignancy
General examination
• Patient is conscious , oriented , afebrile .
• Severe pallor +
• Bilateral pitting pedal edema +
• No icterus , clubbing , cyanosis , lymphadenopathy.
• Vitals
• BP- 100/60 mm hg in right upper limb in supine position , no postural drop
• Pulse - 108/min , normal volume , regular rhythm , no special character,
no radio radio-radial and radio-femoral delay.
• RR- 18 per minute, Thoraco-abdominal type
• Spo2 99% in room air.
• Temp- afebrile
• Spine normal
• No external markers of TB or malignancy.
• No tatto marks.
ABDOMEN
Examination

• Oral cavity - tongue appears pale and bald.


• INSPECTION
• All quadrants appear to move equally with respiration.
• Umbilicus is in the midline , inverted .
• No scars , sinuses , dilated veins or visible pulsations.
• Divarication of recti present
• Hernial orifices free.
ABDOMEN
EXAMINATION
• PALPATION
• Measurements

• Abdominal girth 78 cms.


• Xiphisternum to umbilicus 17cm
• Umbilicus to pubic symphysis 17cm
• ASIS to umbilicus 18 cm on both sides.
• LIVER - Mass felt 2cm below the right costal margin in mid clavicular line,
firm in consistency, smooth surface , sharp border, non tender , moves
with respiration and non pulsatile.
• Left lobe of liver not palpable.
• SPLEEN- Mass felt 11 cm below the left costal margin along the direction of
the splenic axis, firm in consistency, smooth surface, tender, splenic notch
palpable, moves with respiration, can’t get above the swelling.
• No other palpable masses in the abdomen.
• Hepato-jugular reflex present.
ABDOMEN
EXAMINATION

• Percussion
• No free fluid in the abdomen.
• Upper border of liver found to be in the right 5th ICS ( liver span 14cms)
• Traube’s space dull on percussion.
ABDOMEN
EXAMINATION

• Auscultation
• Bowel sounds regular
• No hepatic bruit , venous hum.
• No splenic rub .
• External genitalia examination unremarkable.
CARDIOVASCULAR SYSTEM
EXAMINATION

• JVP elevated
• S1 S2 + systolic flow murmur heard in all areas
• Loud P2+
RESPIRATORY SYSTEM
EXAMINATION

• Bilateral normal vesicular breath sounds heard


• Bilateral basal crackles heard
• No wheeze

• CNS examination –
no focal neurological deficit.

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