Patient management

20/5/19 Unit HO

Pt still complained of abdominal pain, though has slightly subsided. Moved bowel

twice, said to be watery and containing some dark particles.

Condition has improved slightly.

O/E: lethargic, Abd girth 104cm, Weight 76kg

V/s RR 28cpm,PR 92bpm, BP 130/100mmHg

Plan was to continue antibiotics, encourage liberal fluid intake as tolerated

21/5/19 Unit HO

Pt complained of mild abdominal pain.

Wt: 75kg, Abd girth: 100cm, FBG: 11.7mmol/L

O/E: Unilateral pedal oedema

V/S PR: 88bpm, BP: 130/90mmHg, RR 30cpm

Assessment: stable

Plan: Pt was encouraged to procure salt poor albumin, and to ambulate and also

liberal fluid intake as tolerated. Current line of management was continued.

Consultant ward round

Pt complained of left sided abdominal and chest pain and does not seem to be

responding to the therapeutic trial of antikoch’s as there is worsening oof the patient’s

clinical state.

O/E cachectic, bilateral pitting pedal edema up to the lower part of the knee, more on

the right. Abdomen was grossly distended, and other findings were aas earlier

documented.

An asssessment of gross ascites ? cause was made. Previous diagnois of abdominal

TB ?? due to failure of response to antiTB drugs after 3 weeks. Lesion seen in chest

(xray?) may be due to someting else ?? mitotic lesions

Plan was to suggest to patient an abd and chest CT scan with particular focus on

lesions in the chest, do an ascitic fluid albumin and serum fluid albumin level,

continue with antiTB drugs in the meantime and continue management.

22/5/19 unit HO

Day 22 on anti Koch’s

Patient complained of inancial constraint concerning the abd/chest CT scan, but had

no fresh complaints.

O/E bilateral pitting pedal edema up to the knee more on the right

V/s PR90bpm, BP 100/80 T36C, RR 25cpm

Assessment: clinically stable

Plan was to encourage patient to do abd and chest CT scan and encourage ambulation

and liberal fluid intake as tolerated. Ongoing line of management was continued.
 HOOC

SAAG 16g/L-3g/L=13g/L ( >11 )

RBG could not be done as patient did not have a glucometer strip

23/5/19 unit HO

Patient has no fresh complaints. FBG could not be done as patient had no glucometer

strip. Also yet to do outstanding investigations-abd Ct scan, chest ct scan and stool

MCS

Input/output=1750/500 ml over the last 24 hours. Weight: 78kg, abd girth: 104cm

V/s T 36C, PR 90bpm, BP 110/70mmHg, RR 26 cpm

Abdomen grossly distended

An assessment of stable clinical state was made

Plan was to encourage ambulation and liberal fluid intake, and continue ongoing line

of management

24/5/19 unit HO

Day 24 on anti Koch’s

Patient was seen but was yet to do abd and chest ct scan due to financial constraints.

He was also yet to do LVP because he was not ready. Had no fresh complaints.
SAAG was done two days ago. Serum albumin 16g/L, ascitic albumin 3g/L;

SAAG=1.3ug/L (13g/L), suggestive of a transudative process.

Inupt/output=1700/600ml over 24 hours

O/E bilateral pitting pedal edema up to the knee, more on the right

Abd girth 104cm, wt 79kg.

V/s PR 94bpm, BP 110/80mmHg, RR 24 cpm

Abd ISQ

An assassment of massive ascites ? was made.

Plan was to encourage patient to do LVP as soon as he is ready, and to do abdominal

and chest CT scan. Other line of management was continued.

SR Ward Round

Patient felt stronger today and had improved appetite. Ascites however is seen to be

worsening. Abdominal girth today was 108cm. He was still yet to do abd and chest

CT scan due to financial constraints.

O/E chronically ill looking, pale, bilateral pitting pedal edema up to the knee.

Abdomen grossly distended,

V/s PR 94 bpm, BP 110/80mmHg, RR 24cpm

An assessment of fair clinical state was made

Plan was to encourage patient to do abdominal and chest CT scan, continue anti

Koch’s medications, tab spironolactone 100mg twice daily, and monitor vital signs

closely.

25/5/19 GIT UNIT Weekend Ward Round

Patient is yet to do abdominal and chest CT scan due to financial constraints. He

declined LVP for now as he wants to feel much better before having it.

No new complaints.

Input/output over the last 24 hours = 2000/800mls

O/E Bilateral pitting pedal edema up to the knee, more on the right

V/s PR 94bpm BP110/80mmHg, RR 26cpm

An assessment of fair clinical condition was made.

Plan was to encourage patient to get funds for chest and abdominal CT scan and to

have LVP. Medications and other lines of management were continued.