A 55y/M Barber by occupation came to OPD with Chief Complaints of 

 • Pedal Edema since 1 month

 • Abdominal Distension, Decreased Urine Output, Facial Puffiness since 1 month

 • SOB on exertion


# HOPI

Patient was apparently asymptomatic 1 month ago after which he developed 

 • Pedal edema -

- Started in both Lower limbs 

- Gradually progressive in nature & extended upto thigh and Scrotum

- Pitting type

 • later patient developed Abdominal distension, facial puffiness, decreased U/O

 • He also complaints of SOB on exertion (grade 2)


No H/o Chest Pain, Palpitations, Orthopnea, PND, Jaundice, Hematemesis, Bleeding PR


# Past H/o

 • No H/o similar complaints in the past

 • Patient has swelling of left scrotum since 10y

 • Patient is not a k/c/o DM, HTN, Asthma, Epilepsy, CAD


# Personal H/o

 • Sleep Adequate

 • Appetite Normal

 • Diet Mixed

 • Bowel Regular

 • Bladder - Decreased U/O since 1 month

 • Addicitions 

- Chronic Alcohol Abuse since 8 years, 100ml daily, last drank 2 daya before the presentation. 

- Chronic Smoker since 20 years, 1pack of beedi for every 2 days. 


# Family H/o 

No Significant Family H/o


# General Examination

 • Patient conscious, Coherent, Cooperative & Well Oriented to time, place, person

 • Examination was done in well light room after adequate exposure and Consent

 • O/E 

- Pulse 82 bpm

- BP 130/80 mmhg

- RR 22 cpm

- Temp Afebrile

- SpO2 99% on room air


 • No signs of Pallor, Icterus, Cyanosis, Clubbing, Generalized Lymphadenopathy

- Generalized Edema (Anasarca)




# Local Examination

CVS 

- Raised JVP

- Apex 5th ICS 1cm Lateral to Mid-clavicular line, Down and Outward

- Para Sternal Heave +nt

RS

- Trachea Central

- BAE +nt

- Crepts in Right ISA, IAA

Abdomen

- Distended with Flanks Full

- Umbilicus Horizontal / Slit like

- Non tender

- Shifting Dullness +nt

- No Signs of Organomegaly

- Bowel sounds normal

CNS: NAD


# Provisional Diagnosis : 

Anasarca Under Evaluation 

? CCF


# Investigations:

CBP

CUE

Sr.Creat

Sr.Urea

LFT

Urinary Protein- Creatinine Ratio

USG Abdomen and Pelvis

USG Scrotum

CXR

ECG

2D Echo













# Diagnosis :

ANASARCA SECONDARY TO RIGHT HEART FAILURE WITH B/L HYDROCELE & B/L FANICULITIS


# Treatment

Day 1 (30/06/2021)

- INJ.LASIX 40mg IV/BD

- INJ.OPTINEURON 1amp in 100ml NS OD

- FLUID RESTRICTION < 1.5l/day

- SALT RESTRICTION < 2gm/day

- Daily Abdominal Girth and Weight Monitoring

- I/O Charting


Day 2 (01/06/2021)

- INJ.LASIX 40mg PO/BD

- INJ.OPTINEURON 1amp in 100ml NS OD

- TAB. OFLOX-OZ 200mg PO/OD

- TAB. PANTOP 40mg PO/OD

- TAB. PCM 500mg PO/SOS

- TAB. TELMA 40mg PO/OD (8AM)

- FLUID RESTRICTION < 1.5l/day

- SALT RESTRICTION < 2gm/day

- Daily Abdominal Girth and Weight Monitoring

- BP/PR/TEMP 4th Hourly. 

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