🔺 CASE STUDY NO : 55 🔺 PART NO :1 🔺 JALODHARA /ASCITIES 🔺NIDANA (ETIOLOGY / CAUSATIVE FACTORS) -Excessive intake of alcohol and heavy, unctuous foods -Suppression of natural urges -Improper treatment of previous Udara rogas -Chronic liver diseases -Intake of unwholesome food (Viruddha Ahara) Reference: "Madya sevanaat, abhighataat, dushta ahara sevanaat cha..." (Charaka Chikitsa 13) Sushruta Samhita, Nidana Sthana 7/13 Ashtanga Hridaya, Nidana Sthana 9/20 🔺 PURVARUPA (PRODROMAL SYMPTOMS) -Mild abdominal distension -Loss of appetite -Feeling of heaviness -Fatigue and laziness -Discomfort in abdomen -Dyspepsia or indigestion -These signs indicate the early derangement of Agni (digestive fire) and doshas. 🔺 LAKSHANA (SIGNS AND SYMPTOMS) -Severe abdominal distension with fluid thrill -Shotha (swelling) in legs -Breathlessness -Dullness, fatigue -Diminished appetite -Fluctuation of fluid on palpation (shabdopeta udara – sound in the abdomen) -Skin over abdomen becomes tight and shiny *Reference:(Charaka Chikitsa 13/39) 🔺 SYSTEMIC EXAMINATION IN JALODHARA (ASCITES) -A. General Examination -Pallor – May indicate anemia or liver disease. -Icterus – Suggests hepatic origin. -Clubbing, cyanosis – Chronic hypoxia or liver pathology. -Edema (pedal edema) – Common in hypoalbuminemia and portal hypertension. -Spider angiomas, palmar erythema – Signs of liver cirrhosis. *Abdominal Examination -Inspection: -Distended abdomen with bulging flanks. -Umbilicus may be everted. *Palpation: -Fluid thrill. -Shifting dullness. -Hepatomegaly or splenomegaly in cases of cirrhosis or portal hypertension. *Percussion: -Dull note in flanks (shifting dullness positive). *Auscultation: -Bowel sounds may be normal, reduced, or exaggerated depending on the cause. *Systemic Examination -Cardiovascular: -Raised JVP (in constrictive pericarditis or heart failure). *Respiratory: -Pleural effusion (hepatic hydrothorax). *CNS: -Hepatic encephalopathy signs: confusion, asterixis. 🔺LABORATORY INVESTIGATIONS & EXPECTED RESULTS -CBC : Anemia, leukocytosis (infection), thrombocytopenia (portal hypertension). -LFT (Liver Function Tests) ↑ Bilirubin, ↑ AST/ALT, ↓ Albumin, ↑ ALP (in liver disease). -KFT (Kidney Function Tests) To assess renal involvement – ↑ Creatinine, ↑ BUN. Serum Electrolytes Hyponatremia, Hypokalemia -Serum-Ascitic Albumin Gradient (SAAG) >1.1 g/dL → Portal hypertension (cirrhosis, CHF). <1.1 g/dL → Malignancy, TB. -Ascitic Fluid Analysis: Appearance: Straw-colored, turbid, or bloody.
-Cell count: Neutrophils ↑ in infection.
-Protein: High in TB/cancer Culture: For spontaneous bacterial peritonitis (SBP). -PT/INR :Prolonged in liver disease. -USG Abdomen :Free fluid, cirrhotic liver, portal vein diameter. -CT Abdomen : complex or malignancy-associated ascites. -Viral Markers (HBsAg, HCV, etc.) : To evaluate viral hepatitis. 🛑https://chat.whatsapp.com/KLufxKFrXwbIIAXLxXDqOB