liver abscess

LIVER ABSCESS

35 year old male came to our hospital with chief complaints of upper abdomen pain since one week, fever since one week.
Patient was apparently asymptomatic 1 week ago, then developed pain abdomen which was insidious in onset, gradually progressive. Pain in right hypochondrium and gastric region radiating towards back with no aggravating and relieving factors.
Fever is on and off since one week, high grade not associated with chills and rigor, cold, cough, body pains, nausea vomitings, loose stools and constipation.
No history of bleeding manifestations.

PAST HISTORY
Not a k/c/o T2DM,HTN,asthma , epilepsy,TB 

PERSONAL HISTORY
Diet - mixed
Appetite - decreased since 1 week
Sleep- inadequate due to pain
Bowel movements- normal
Addictions- alcohol, regular, since 10 years
Smoking, 10 pack years

General physical examination
Pt is conscious, coherent, cooperative, 
Icterus- present 
 Vitals-
Temp- afebrile 
Bp-110/70 mm hg
Pr- 86 bpm
Rr-20 cpm
Spo2- 98% on RA

Vitals on 2-2-22
Bp 100mmhg
Pulse 72
SpO2 - 98
Resp - 24 bpm

Systemic examination
RS- bae+, nvbs
Cvs-S1 S2 +
P/A - 
Inspection:
Shape - distended ,uniformly
Umbilicus - centrally positioned , inverted
Skin - stretched
No dilated veins

On superficial palpation:
tenderness + at right hypochondrium and epigastric region, umbilical and Rt lumbar 

Auscultation:
Sluggish bowel sounds heard
Cns- nad
                   X-ray erect abdomen


                    

                   


                     


Diagnosis
Liver abscess

Plan of treatment 
1. Inj. Metrogyl 100 ml/IV/TID
2. Inj. Pantop 40 mg/IV/OD
3. Inj. Piptaz 4.5 gm/IV/TID
4. Inj. Tramadol 1amp in 100mg

Time line


USG -shows 50% liquefaction




Day 2 

S - pain abdomen subsides
One fever spike in morning 

O - on examination 
Patient is concious, cherent
Icterus- present

Vitals-
Temperature- 99.6
Pulse rate- 96
Blood pressure- 110/80
Respiratory rate- 22
Spo2- 96% at room air 

Systemic examination-
Cardiovascular system- S1 and S2 heard, no murmurs
Respiratory system- bilateral air entry present, normal vesicular breath sounds
Central nervous system- NAD
P/A- MILD TENDERNESS PRESENT 


A - liver abcess 2 to ? amoebic/pyogenic

P- 
1. INJ. METROGYL 750MG/IV/TID
2. INJ. MAGNEX FORTE 1.5MG/IV/BD
3. INJ. PAN 40MG/IV/OD
4. INJ. OPTINEURON 1 AMP IN 100ML NS/IV/ OVER 30 MIN
5. INJ. TRAMADOL 100MG IN 100ML NS/IV/OVER 30MIN/ SOS
6. INJ. THIAMINE 1AMP IN 100ML NS IV/OD



Day 3

S - pain abdomen decreased compared to yesterday
No fever spikes 

O - on examination 
Patient is concious, coherent
Icterus- present

Vitals-
Temperature- 98.6
Pulse rate- 96
Blood pressure- 110/70
Respiratory rate- 20
Spo2- 98% at room air 

Systemic examination-
Cardiovascular system- S1 and S2 heard, no murmurs
Respiratory system- bilateral air entry present, normal vesicular breath sounds
Central nervous system- NAD
P/A- MILD TENDERNESS PRESENT 


A - liver abcess 2 to ? amoebic/pyogenic

P- 
1. INJ. METROGYL 750MG/IV/TID

2. INJ. MAGNEX FORTE 1.5MG/IV/BD

3. INJ. PAN 40MG/IV/BD

4. INJ.  THIAMINE 1 AMP IN 100ML NS/IV/ OD OVER 30 MIN

5. INJ. TRAMADOL 1 AMP IN 100ML NS/IV/OVER 30MIN/ SOS

6. INJ. DICLOFENAC 3ML=75MG IM/BD

7. TAB. PCM 650 MG PO/QID

8. INJ. NEOMOL 1G IV/SOS

Comments

Post a Comment

Popular posts from this blog

A 32 year ald male

Image
 complaints: Patient complaining of decreased appetite since 10 days , fever since 10 days Vomiting since 7 days associated with pain in abdomen, History excessive alcohol intake since 1 month , aggrevated since last 7 days Loss of weight since 10 days  No H/O fever and lose stools History of presenting illness :  Patient is asymptomatic 10 days back then he had loss of appetite and took no food since then and had excess of alcohol . He developed low grade fever 10 days back , sudden in onset , low grade , intermittent , relieved on medication, associated with rigors , no sweating and no evening rise of temperature. Vomiting since 7 days back , multiple episodes in a day like every 1 hour , bilious, Foul smelling, non projectile , not associated with abdominal pain , no headache, no diminision or blurring of vision . Past history:  No history of Diabetes mellitus, Hypertension, TB , Asthma and No history of any cardiovascular disease History of 2 episodes of admission in hospital in vi
Read more

35 year old with shortness of breath

Image
CHIEF COMPLAINTS A 35 year old who is painter by occupation came with chief complaints of shortness of  breath and fever since 1 week.  HISTORY OF PRESENT ILLNESS  Patient was apparently asymptomatic 1 week back, then he developed  • shortness of breath on exertion, since 1 week. • high-grade fever since 1 week, more during night, relieved on medication and relapses back. • decreased urine output since 1 week • dragging type of pain in both legs and hands, associated with generalised weakness. • orthopnea and PND present since 4 days HISTORY OF PAST ILLNESS No history of DM, HTN, TB, Epilepsy, leprosy, CAD, CVN, Asthma or any other chronic illness. No history of previous transfusion.  PERSONAL HISTORY Built : Weakly nourished Appetite : Decreased since 1 week Diet : mixed Sleep : Decreased since 1 week  Bladder movements:  Anuria since 1 day associated with burning micturition. Bowel movements: regular Addictions : toddy consumer in summer season. Regular alcohol consumer, once a week.
Read more

65 year old male

Image
Chief complaints :  65 year old male with chief complaints with unable to walk since 3 months , muscle stiffness since 20 days , decreased appetite since 15 days . Unresponsiveness since 3 days.  History of presenting illnesses: Patient is apparently asymptomatic 1 year back then developed unbalanced gait,insidious in onset and visited a hospital ,6 months ago and was said to be having a neurological disease (no documents available) and have been using medication since then(not known)and was having generalised weakness on and off since 6 months and due to fear of falling and as he is feeling pricking sensation over the sole,and due to decreased power in his limbs and generalised weakness he completely stopped walking  and was bed ridden since 2 months(he didn’t tried walking even with support)visited a hospital again 1 month back,MRi brain was done,showing hydrocephalus and early parkinsons changes,and advised for surgery (?Ventriculoperitoneal shunting,not done)and during hospital sta
Read more