A 35 YEAR OLD MALE WITH LIVER ABSCESS

 "This is an online E log book to discuss our patient's de-identified health data shared after taking his/her/guardian's signed informed consent. Here we discuss our individual patient's problems through series of inputs from available global online community of experts with an aim to solve those patient's clinical problems with collective current best evidence based inputs. This E log book also reflects my patient-centered online learning portfolio and your valuable inputs on the comment box"


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 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- adequate
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

Systemic examination
RS- bae+, nvbs
Cvs-S1 S2 +
P/A - tenderness + at right hypochondrium and epigastric region
Sluggish bowel sounds heard
Cns- nad





                   X-ray erect abdomen


                    Ultrasound abdomen
https://youtube.com/shorts/gambTd0a-y8?feature=share

FEVER CHART


ECG




                      Investigations
3/2/22
HB-10.2
TLC- 17,900
PLT- 5.1

Serum amylase- 60 
Serum lipase- 28

RFT
Serum urea- 37
Serum creatinine- 1.1
Sodium- 130
Potassium- 6
Chloride- 98

3/2/22
LFT
TB- 4.40
DB- 3.12
AST/ALT- 96/145
ALP- 586
TP- 5.3
Alb- 2.6
A/G- 0.94

PT -17 sec
APTT- 34 sec
INR- 1.25 








                     Surgery referral


Diagnosis
Liver abscess secondary to ? Amoebic or pyogenic 

Plan of treatment 
1. INJ. METROGYL 750MG/IV/TID
2. INJ. MAGNEX FORTE 1.5MG/IV/BD
3. INJ. PAN 40MG/IV/BD
4. INJ.  THIAMINE1 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

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