A 55 year old female with abdominal distention

A 55 year old female presented to the OP with chief complaints of abdominal distention and shortness of breath since 15 days
  
HOPI:
          The patient was completely normal 1 month ago. since 15 days she was complaining of abdominal distention which was  with pain which  subsided on taking medication. She was having episodes of mild fever once in a while which subsided when she had Dolo.She also had frequent episodes of shortness of breath and also faced difficulty in walking. The patient also complained of bilateral edema of both the lower extremities.

Past History: 9 years back she was diagnosed with hypothyroidism.
                        4 years back she was diagnosed with Diabetes millions type 1

Family History: No significant family history 
Personal History: 
                                Diet : Mixed diet
                                Appetite :Decreased since 15 days
                                Sleep : inadequate (disturbed sleep)
                                Irregular bowel movement
                                Normal micturition
                                No addictions
Drug history: No significant drug history 

General Examination:
                  Moderately built
                   Conscious and coherent
                   Cooperative 
       Pallor is seen
       No icterus 
       No cyanosis
      No lymhadenopathy
     Bilateral pedal edema is seen which is of pitting type
     
   Vitals : 
                 Temperature : febrile 102 degrees
                 Pulse rate -80 bpm
                Blood pressure :130/70 mmhg 
                Respiratory Rate: 18cpm
                GRBS : 174mg/dl
Diagnosis: Ascites with secondary liver damage

                             

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