31 year old female with chronic liver disease

Pt came to casualty with complaints of 
1.abdominal distension since 10 days
2.pedal odema since 10 days
3.SOB on exertion since 10 days
4.generalised weakness since 10 days

Patient is apparently asymptomatic 4months ago and she developed fever which is insidious in onset,low grade, intermittent,no diurnal variation not associated with chills and rigor. 

Vomiting insidious in onset,non projectile, non bilious, less quantity,odorless,non blood stained,content is food. 

Then she noticed yellowish discoloration of eyes, initially noticed in eye with high coloured urine and loss of appetite. 

Not associated with pruritis,clay coloured stool.

For which she took herbal treatment for 1 week,after which there is no improvement .

Then she went to local hospital at miryalguda and tested positive for HbSAg she took treatment for 10 days and no improvement is observed 

Then she went to Gandhi hospital and took treatment 1month 10days for the similar complaints and no improvement is observed. 

Then she went to a hospital at khammam took treatment only for 2 days as they could not afford treatment they went to home.

At home she didn't take any medication for 10 days. 

Then she came to our hospital with the complaints of 

Abdominal distension which is insidious in onset,gradually progressive since 10 days

Swelling of both legs below the knees since 10 days which is insidious in onset,gradually progressive. It started at ankles and extending up to the knees.

 History of decrease urine output,constipation since 10 days.

No history of abdominal pain,shortness of breath.
Decreased appetite
Ammenuria since 3 months
Decreased sleep
Decreased urine output

Vitals on admission 
Pt has pallor,icterus,pedal oedema
No cyanosis,clubbing, lymphadenopathy
Pt is c/c/c
Afebrile
BP:100/60mmhg
PR:84bpm
RR:20cpm
CVS:s1s2+
RS:BAE+
P/A:soft,non tender
Abdomen size- distended
Fluid thrill+, shifting dullness+
Bowel sounds present
CNS:NFND

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