MEDICINE

 46 year old , male resident of Devarkonda occupation : driver Came for regular dialysis  During dialysis , he developed cough with hemoptysis ( 200ml ) saturations: 60spo2, got intubated.  Past h/o : patient was apparently normal 8 months back, then he developed back pain , burning micturition, loss of appetite , decrease urine output.  Back pain which was insidious on onset , gradually progressive no reliving and aggrevating factors for which he went to a near by RMP , pain subsided.  After 2 months he developed sudden SOB, went to devarkonda hospital , For which they said he has kidney problem, had to go for dialysis.  Later, he came to Kamineni Narketpalli  Underwent dialysis , during dialysis he had COUGH, SOB, FEVER.  Totally 10 dialysis done till last month.  During the stay in hospital, he had one episode of seizures ( GTCS  type) not a k/c/o seizures  On tab: LEVIPIL.  Later he was discharged , he was sent to Hyderabad for FISTULA .  On the way , going to Hyderabad attenders o

Q1 Reason for this ascites        The most common cause of Ascites is       Cirrhosis of liver        risk factors in this patient :       1. Chronic alcoholism since 40 years       2. Truncal obesity leading to metabolic syndrome causing NAFLD leading to cirrhosis           https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6092576/ Q2 Bilateral pedal oedema which is of pitting type is due to decrease in the albumin level trends due to course of the disease and long standing cirrhosis causing decrease in the production of proteins causing decrease in the oncotic pressure leading to accumulation of fluid. as per the given clinical data due to chronic liver disease there was increasing trend of INR which was as high as 4.7 causing bleeding manifestations ( bleeding gums, hematoma formation )  ulcerations are due his limited self practising manoeuvres done in inappropriate conditions such as improper dressing of the wound, not maintaining aseptic conditions , indescriminate use of steroids (se