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“My belly keeps filling with fluid, and I don’t feel well.”
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History of Present Illness
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SB is a 49-year-old female with a PMH of HCV who presented with complaints of sharp, constant abdominal pain and swelling.
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Measles at age 5, recurrent OM
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+ EtOH, (–) tobacco, (–) illicits
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Up-to-date on all childhood immunizations
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Two pins in R great toe s/p bunion repair
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Mother: MI, DM2, dyslipidemia, obesity
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Father: DM2, obesity, deceased at age 50
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SB currently lives with her mother. She works a full-time job as a teller at the local credit union.
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Cachectic appearing female in NAD, supine in bed
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Temp 101.5°F, HR 80, BP 108/72, RR 16 breaths per minute, SpO2 98% RA, Ht 5′4″, Wt 46 kg
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Jaundice, no rashes or bruises
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AT, bitemporal wasting, PERRL b/l, no ptosis, + scleral icterus, nares patent, MMM
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RRR, no m/r/g, severe pitting edema to level of abdomen
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Taut, distended, fluid wave, midline large hernia, caput medusae, RUQ guarding, hypoactive bs, massive ascites
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Sensation intact, CN II-XII intact, strength 5/5 in UE and LE, + asterixis, + ataxia
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Appears confused, somnolent
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