1702102086 LONG 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 15days.

History of present illness-

Patient was asymptomatic 15 days back and then he developed fever, pain in the abdomen in upper right quadrant since 15days, relieved with medications. 

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/0 burning micturition

No other complaints 

Past history-

H/o similar complaints( abdomen pain and vomitings) in the past due to which he visited local doctor, relieved on medications.

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

1 year back episodes reoccurred - 2 episodes in july and august 2021.

Had treatment for seizures in the past.

No surgical history.

Personal history-

Appetite: decreased since 15days,

Diet: mixed

Bowel - bladder: regular 

Sleep: disturbed due to pain,

Addictions: chronic alcoholic since 15 yrs : 180ml everyday

Chronic smoker since 15 yrs : cigars 3-4/day


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

No murmurs 

RS:

BAE+ ,NVBS heard

CNS:

NFND


Fever charting-



Investigations-
24/9/21-

Haemogram-
Hb-11.9
Tlc-19,000
Plt-3.55
Rft-
Blood urea-14
Serum na-141
Sr.k+ 4.5
Sr.cl- 54
Sr.creat- 1.0 
Serology-hbsag,hiv,hcv-negative



Ecg-
Chest x-ray:




Ultrasound abdomen-



Haemogram-25/9/21-

On 26/9/21-



Haemogram-27/9/21


Diagnosis : Liver abscess (?Amoebic)

Plan of care:

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
9.bp,pr monitoring 6th hourly.

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