1702102021 SHORT CASE

A 40 year old male with pain in abdomen and fever

A 40year old male came to casualty with chief complaint of pain in the abdomen and fever since 15 days.

History of present illness-

Patient was asymptomatic 15 days back and then he had

History of fever since 15days which is low grade, associated with chills and rigor, increased in the evening time, relieved with medications. 

History of abdomen pain since 15days, right hypochondriac region ,  insidious onset, gradually progressive, pricking type, radiating to the back , relieved with treatment.

No history of vomiting , loose stools, abdomen distention. 

No h/o cold/cough/sob

No h/o burning micturition

No other complaints 

Past history-

No h/o DM/HTN/Asthma/CAD/TB

H/o seizures- since childhood- at age 5-6 years

Had treatment for seizures in the past.

No surgical history.

Personal history-

Appetite: decreased since 15days,

Diet: mixed

Bowel - bladder: regular 

Sleep: decreased

Addictions: chronic alcoholic and smoker since 15 yrs 

On examination:

Vitals: 

Temp: afebrile

Pr- 78/ min

Bp- 130/90 mmhg

Spo2: 98% at RA

There is no pallor, icterus, cyanosis, clubbing, lymphadenopathy.




Systemic examination:

Per Abdomen:

shape - scaphoid  and symmetrical.

Tenderness in right hypochondrium

No visible pulsations.

No palpable masses

Liver and spleen not palpable 


CVS: S1 , S2 heard ,Nomurmurs 

RS: BAE ,NVBS heard

CNS: NFND


Fever charting-



Investigations:

Haemogram-
Hb-11.9
Tlc-19,000
Plt-3.55

Rft-
Blood urea-14
Sr.creat- 1.0 
Serum Na+ 141
Sr.k+ 4.5
Sr.cl- 54

Serology-hbsag,hiv,hcv-negative

Ecg-

Chest x-ray:



Ultrasound abdomen-

Findings - E/o - 6.3×5.3cm heteroechoic lesion noted in segment VII in right lobe of liver ( not well defined) 

Impression - liver abscess as described


Diagnosis :

Liver abscess (? Amoebic)

Treatment:

1.plenty of oral fluids
2.inj.metrogyl 750 mg IV tid
3.tab.pan 40 mg po od
4.inj.optineuron 1 amp IV od
5.inj.tramadol 1 amp in 100 ml NS IV sos
6.tab.ultracet 1/2 tab /po/qid
7.tab.pcm 650 mg /po/sos
8.inj.piptaz 4.5 mg/IV/tid

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