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Chief complaint
A 40year old male patient farmer by occupation presented to opd with complaints of pain in the abdomen associated with fever since 15days
History of present illness
Patient was apparently asymptomatic 15days back.He,then developed pain in the abdomen-right hypochondriac region which is insidious,pricking type gradually progressive and radiating to the back.Patient also complains of fever since 15 days -high grade which is continuous associated with chills and rigor.
History of vomtings- 3 episodes projectile and non-bilious with food as content
History of weight loss is present
Past history
Known case of epilepsy since childhood.Last 1year patient had 4 episodes of seizures (first 2episodes occurred in the same month and the later 2 with a duration gap of 2-3 months)
No history of diabetes,hypertension .
Personal history
Apetite- decreased
Diet-mixed
Bowel and bladder -normal
Sleep-disturbed due to pain
Chronic alcoholism since 4years-180ml/day
Smoking-3 cigars/day
Family history
No relevant history found
General Examination
Patient was conscious, coherent and cooperative
No pallor,icterus,clubbing,cyanosis
No lymphadenopathy
Vitals
Temperature : febrile
Pulse rate-78/ min
Bp- 130/90 mmhg
Spo2: 98% at RA
SYSTEMIC EXAMINATION
CARDIOVASCULAR SYSTEM:
Inspection:
Chest wall is bilaterally symmetrical.
No precordial bulge.
Palpation:
JVP: normal
Auscutation:
Normal with regular heartbeat
S1, S2 heard
No thrills.
No murmurs
RESPIRATORY SYSTEM-
Position of trachea: central
Normal Bilateral air entry
No dyspnoea
No wheeze
Breath sounds: vesicular.
PER ABDOMEN
shape - scaphoid and symmetrical.
Tenderness in right hypochondrium
No visible pulsations.
No palpable masses
Liver and spleen not palpable
CNS
Level of consciousness:Alert.
Speech: normal.
No signs of meningeal irritation.
ULTRASOUND ABDOMEN
Findings-
E/o: single heteroechoic lesion seen on the segment-7 on the right lobe of liver
Gall bladder and urinary bladder are partially distended
X-ray
FEVER CHART
HEMOGRAM
SERUM ELECTROLYTES
LIVER FUNCTION TEST
BLOOD UREA
SERUM IRON
SERUM CREATININE
BLOOD SUGAR
HIV RAPID TEST
ANTI HCV ANTIBODIES-RAPID
PROVISIONAL DIAGNOSIS
Liver abscess (un liquified)
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
9.bp,pr monitoring 6th hourly.
Questions
1.Are there any other etiological factors for liver abscess formation rather than chronic alcoholism??if present what are their effects on liver function??
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