General medicine E-Log of 42 year old patient with HF.

A 42 year old male patient, he is an electrician. came to the casuality.
Cheif complaints:
1.shortness of breath since 1 week
2.Abdominal distension since 1 week
3.Fever
4.Bilateral pedal edema up to ankle since 4 to 5 days.
1 year back diagnosed with Tuberculosis used medication for 4 days and stopped.
Present illness:
Patient was apparently asymptomatic till July 21 when he was admitted here in Kims with symptoms of SOB , pedal edema ,
 with COPD, with ULCER ON LEFT FOOT managed conservatively with diuretics, beta blockers , one episode of AF ( paroxysmal) resolved.

Patient continued to consume alcohol 15days after discharge with increased binge drinking since 10days , followed by cough, productive, no diurnal variation , associated with low grade fever and SOB , progressed to grade 4 gradually, associated with orthopnea , with abdominal distension and bilateral pedal edema upto ankle.

From the past two days he complains of low grade intermittent fever with generalized weakness and shortness of breath (grade 2-3).

No history of  pain abdomen, vomiting, loose stools
No history of cough, chest pain
No history of decreased urine output/ burning micturition and no other complaints.
Personal history:
Not a k/c/o diabetes/ hypertension/ asthma/epilepsy.
K/c/o alcoholic 180ml whiskey/day since 20yrs .
Gutka consumption since 20yrs.
Past history:
In 2018 his left foot big toe got hit by iron rod during work, used pain killers but did not subside , foot got swollen the next day, he came to our hospital that day , skin flap from right thigh is grafted to his left foot. He used regular medication for given period. He was fine till 2yrs, then got diagnosed for TB , used medication only for 4days . 

Now before 3months , he got admitted due to jaundice in our hospital, after admission,next day he developed ulcers on left foot ankle, treatment was being given, now again multiple ulcers were developed.
GENERAL EXAMINATION:
The patient is conscious.
Icterus is present.
Pedal edema is present.
Absence of pallor, cyanosis, clubbing, lymphadenopathy.
Afebrile.
VITALS:
1.Temperature:- 97.5 F
2.Pulse rate: 108 beats per min
3.Respiratory rate: 21 cycles per min
4.BP: 110/70 mm Hg

CVS examination:
Parasternal heave is seen
Apex is visible, diffuse.
Heart sound are audible.
No murmers.
Respiratory system examination:
 Dyspnea is present 
Wheezing is present, bilateral end inspiration.
Position of trachea is central

PER ABDOMEN:
Abdomen is Soft,Distended.
No tenderness is seen.
Shifting dullness is seen,
Bowel sounds are audible.
multiple ulcers and pedal edema are also present 
Blood investigations:
On 20/10/2021-
Chest x ray:
On 20/10/2021
Blood investigations:
On 21/10/2021
Chest x ray:
On 21/10/2021

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