A 56 year old woman with ascites

A 56 year old woman from narketpally, who is a housewife came to OPD with the chief complaint of distension of abdomen associated with pain since 10 days

History of present illness-
Patient was asymptomatic 10 years ago.
She then visited hospital for a routine check up and was diagnosed with hypothyroidism, Hypertension and Diabetes.

She was on hypothyroidism medication for 2 years before she was told the levels were back to normal. But she was diagnosed with the same(hypothyroidism) 3 yrs later for which she is under the same medication
Tab. Thyronorm 50mg oral BD

She was on Hypertension and Diabetes  medication for 2 years and stopped. She resumed the medication 3 years later.
Tab. Telma 40mg oral BD
Tab. Metformin 500mg oral BD

She developed shortness of breath and cough since 6 years. She was on medication for a year and stopped.
She was diagnosed with asthma 1 year later for which she is on medication.

10 days ago she came to OPD with abdomen distension for which she was given pantop.
But she developed more distension, severe pain and had no appetite within 24 hours of medication.
She was then advised to get admitted in the hospital which she did on 4/8/2022.

Past history- 
No such complaints in the past

Personal history-
Diet: mixed
Appetite: decreased since 6 months.
Sleep: inadequate 
Bowel: intermittent constipation since 20 years
Bladder: regular
Addictions: pan 10 years ago

Family history-
Mother with Hypertension 

Menstrual history-
Menarch- 13yrs
Menopause- 46yrs
No h/o cramps, clots

Obstetrics history-
P1L1- son FT, NVD
P2L2- son FT, NVD. Now 38 years old

General Examination-
Patient was conscious coherent and cooperative
Moderately bulit and nourished
Pallor - present 
No Icterus , Clubbing, Cyanosis, Generalised lymphadenopathy
Bilateral pedal edema present pitting type

Vitals-
Pulse: 101bpm
BP: 130/70
Respiratory rate:18cpm



Investigations-










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