Swathibogari

37 yr old male came with c/o tingling sensation in left upper and lower limb Numbness prsent Slurring of speech present lasting for 1-2 mins Pt was apparently asymptomatic till yesterday afternoon where patient developed tingling sensation and numbness associated with slurring of speech lasting for 1-2 mins  No h/o deviation of mouth ,unable to lift left upper and lower limb ,drooping of eyelid or loss of labial fold 2nd episode - similar episode occured in the evening around 6 pm later today morning they went to local doctor  O/E: bp was 210/140mmhg Routine investigation were done  Ct brain was done which was given as normal they were referred  for further management   No significant past history   No similar complaints in past   Not k/c/o T2 DM,HTN,asthma ,tb,epilepsy  Personal: Pt has mixed diet   No loss of appetite  Bowel and bladder movements regular   O/e : pt is c/c/c  Afebrile to touch   Pr -110bpm  Bp -220/130 mmhg   Rr- 20cpm  Cvs - s1s2 heard ,no murmers  Rs-b/l air en

Case 1 https://swathibogari158.blogspot.com/2020/09/chronic-decompensated-liver-disease.html Q1  Reason for this patients ascites  Might be due to liver cirrhosis  1.reduced albumin synthesis causes decreased oncotic pressure and transudation of fluid 2.reduced aldosterone metabolism causing  no aldosterone in circulation activating RAAS  , salt and water retension causing ascites 2) Why did the patient develop bipedal lymphedema? What was the reason for the recurrent blebs and ulcerations and cellulitis in his lower limbs?   A) underfilling of circulation due to hypoalbuminemia and salt water retention causes splancnic vasodilation that increases splanchnic arterial pressure and increases permeabilty which increases lymph accumulation Ulcers might be due to  Lymph stasis causes thickening of skin due to protein crosslinking which might cause inadequate circulation gradually ischemia and he mighy have developed ulcers 3) What was the reason for his asterixis and constructional apraxia