Case 2

A 49yr old male patient resident of miryalguda labourer by occupation came to the OPD with chief complaints of 
fever since 15 days
Difficulty in breathing since 15 days
Abdominal distension since 15 days

History of present Illness

- Patient was apparatly asymptomatic 15 days ago then he developed fever which was high grade , intermittent , associated with chills. fatigue and loss of appetite for which he went to the RMP doctor no relief was noticed.
- Later he developed Abdominal distension and Shortness of breath on exertion which was not subsided with medication
- He also had history of Vomitings -1-2 episodes/day which were bilious, non projectile associated with food particles lasting for 4 days and was subsided with medication.
- History of Loose stools since 15 days 2-3 episodes/day it is watery, foul smelling and subsided with medication.
- There is no significant negative history

Past History
- He is not a known case of  Hypertension , Diabetes mellitus , Asthma , Epilepsy, Cardiovascular diseases , thyroid  
- He had surgery for multiple rib fracture - 4 years back
- There is history of blood transfusion-4 years back at the time of surgery  

Personal History
- Diet Is mixed , Appetite is decreased , bowel and bladder movements are normal , sleep is adequate , He is a chronic alcoholic since 20 yrs about 180ml 

Personal history
- There is no significant family history

General examination
- The patient is conscious , coherent and cooperative 
- Moderately built and well nourished 
- There are signs of icterus and edema of feet which is of mild and pitting type 
- There are no signs of pallor , Cyanosis , clubbing , koilonychia , lymphadenopathy 

Vitals
Temperature - afebrile
BP - 110/80mmhg
PR - 73bpm
RR - 18cpm

Inspection

Per abdomen
Shape of abdomen is distended, there are no visible scars, sinuses or engorged veins 
Umbilicus appears normal
All quadrants of abdomen are with equally with respiration

Palpation -

There is No tenderness , free fluid-present
Shifting dullness present
Liver is palpable, 
spleen is not palpable 

Auscultation- 
bowel sounds are heard 

Probable diagnosis
Acute kidney injury with Sepsis

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