A 40yr old male patient 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 patients 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 comment box is welcome

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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