A 40 year old male presented to opd with chief complaint of pain in right loin region and right iliac region, fever, vomiting, cough,burning micturition

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A 40 year old male presented to opd with chief complaints of pain in right loin region and right iliac region since 4 days 

Fever since 7 days 

1 episode of vomiting before admitted 

Cough presents for 20mins at night 

Burning micturition slowly since 6 months 

 

HISTORY OF PRESENT ILLNESS :

 Patient was apparently asymptomatic 1 week ago later he developed pain which is sudden in onset , dragging type started at loin region shifted to flank and front side 

 Fever which is sudden in onset , intermittent type , stepladder , associated with chills and rigors and sweating decreased on medication 

Vomiting which is non- bilious , non projectile, food as content 

Cough which is productive associated with sputum lasted 10min , pain increases with cough 

Got daignosed with S.typhi + 2 days back 

HISTORY OF PAST ILLNESS:

USG showed hepatomegaly and G7 fatty liver 

Not a known case of DM , HTN , Asthma , Epilepsy 

PERSONAL HISTORY:

Non vegetarian 

Appetite :lost 

Sleep is adequate 

Bowel and bladder movements irregular since 4 days 

Chronic alcoholic since 20years stopped 1 week back . Drinks 250ml per day 

Gutka since 20 years (more usage )

Cigarette since 20 years stopped 5 years ago 1 pac daily 

FAMILY HISTORY: 

No similar complaints in family 

GENERAL EXAMINATION: 

Patient is conscious , coherent , cooperative , well oriented 

No pallor, icterus , cyanosis, lymphadenopathy, pedal edema 

Vitals : 

Temp: afebrile 

PR: 78 bpm

RR: 40cpm

BP: 110/80mmHg

SPO2 : 99% 

SYSTEMIC EXAMINATION: 

CVS: 

S1 S2 heard 

No thrills 

No cardiac murmurs 

RESPIRATORY SYSTEM: 

 Position of trachea is central 

Bilateral air entry is normal 

Normal vesicular breath sounds heard 

No added sounds 

PER ABDOMEN : 

 Abdomen is soft , tender in right hypochondrial and epigastric region 

CNS: 

Patient is conscious 

Speech is present 

No focal deficit

No meningeal signs 

PROVISIONAL DAIGNOSIS: 

Liver abscess , alcohol and tobacco dependence 

INVESTIGATIONS: 

Complete blood picture: 

Hemoglobin: 12.7 gm/dl

Total count : 12400cells/cumm

Neutrophils: 75% 

Lymphocyte: 20% 

Eosinophils: 02% 

Smear : Normocytic normochromic with leucocytosis

ESR

LFT

SERUM ELECTROLYTES

LIPASE

SERUM AMYLASE

LDH

URIC ACID SERUM 

BLOOD UREA

BLOOD SUGAR RANDOM

ANTI HCV ANTIBODIES

HBsAg 

 

USG

TREATMENT

DAY1 

- inj metrogyl 750mg IV/tid 

- inj buscopan 2cc po/od IV

- tab pcm 500mg po/od

- tab ultracet 1/2

DAY 2

- inj metrogyl 750mg IV/tid 

- inj buscopan 2cc po/od IV

- tab pcm 500mg po/od

- tab ultracet 1/2

- tab pan 40 mg po/od

DAY 3 

- inj metrogyl 750mg IV/tid 

- inj buscopan 2cc po/od IV

- tab pcm 500mg po/od

- tab ultracet 1/2

- tab pan 40 mg po/od

- inj Ciprofloxacin 500mg IV od

 DAY 4 

- inj metrogyl 750mg IV/tid 

- tab pcm 650mg po/od

- tab ultracet 1/2

- tab pan 40 mg po/od

- inj Ciprofloxacin 500mg IV od

- syp lactulose 15ml po 

- How common is the bacterial disease of liver 

- what are the types of liver abscess 

- what causes pyogenic liver abscess

- how do infections in organs cause liver abscess 

- which conditions are associated with secondary pyogenic liver abscess

GRABS: 105 mg%