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Multiple liver abcess

            Multiple  liver  abcess 

 This is online E-blog, to discuss our patient de-identified health data shared after taking her guardian's signed informed consent.Here we discuss our individual patient problems through series of inputs from  available global online community of experts with an aim to solve the patients clinical problem with current best evidence based input.This E-blog also reflects my patient's centred online learning portfolio.


I have been given this case to solve in an attempt to understand the topic of "Patient Clinical Data Analysis" to develop my competency in reading and comprehending clinical data including history, clinical findings, investigations and come up with a diagnosis and treatment plan.

60 year old female came to casualty with chief complaints of fever since 6 days, decreased appetite snice 6 days, pain abdomen                                                                                                                          history  of presenting illnes 

 Patient was apparently asymptomatic 6 days back then she developed fever which is high grade associated with chills,not associated with cold,cough,burning micturition.

Appetite decreased not associated with nausea,vomitings,loose stools,constipation, weight loss.

Pain abdomen which is diffuse,pricking type ,radiating,aggravated on right lateral position and relieved on sitting.

Pt went to miryalaguda care hospital I/V/O fever,decreased appetite on 17/6/21.usg abdomen showed mild hepatomegaly with multiple                                                                                     HISTORY  OF PAST ILLNESS    

Not k/c/o HTN,diabetes, asthma,tuberculosis,epilepsy

 

Personal. HISTORY 

  • *Married*Occupation:labourer*Appetite:normal *Diet:mixed *Bowel and bladder:regular*No known allergies*Alcohol history*-intake of whisky twice a week*-180ml


Family history 

  • Not significant 

Physical examination 

  • No pallor,icterus,cyanosis,clubbing,lymphadenopathy, oedema

  • Temperature:101F
  • PR:108bpm
  • BP:100/70mmhg
  • RR:24cpm
  • SpO2:95%
  • GRBS:100mg/dl

Syestemic  examination 


  • Abdominal examination 

 InspectionShape -scaphoidUmblicus-invertedEqual movements in all quadrantsNo visible pulsation,dilated veins,localized swellings

Palpation*Local rise of temperature in right hypochondrium*Tenderness in epigastrium and right hypochondrium *Guarding and rigidity in epigastrium and right hypochindrium*Mild enlargement of liver

Percussion *Uppet border of liver is *Liver span*Fluid thrill and shifting dullness absent 

Ascultation 

Ascultatory findings are normal



CVS :No thrills,no murmurs,s1 and s2 heard


RESPIRATORY SYSTEM 

  •  bilateral air entry present,NVBS,no crepts


CNS 

Provisional diagnosis 

  • Multiple liver abcess


Investigations 














































































Treatment 

Day   Iv fluids -NS,RL,DNS @75ml/hr    INJ METROGYL 750mg IV/TIDINJ PANTOP 40mg IV ODINJ ZOFER 4mg IV/SOSINJ TRAMADOL 1 AMP in 100ml NS slow IV /ODINJ OPTINEURON 1 AMP in 100ml NS IV/ODTab PCM 650mg PO/TIDBp/pulse rate/temp  4th hourlyGRBS 6th hourly


Day 2Iv fluids -NS,RL,DNS @75ml/hrINJ METROGYL 750mg IV/TIDINJ PANTOP 40mg IV ODINJ ZOFER 4mg IV/SOSINJ TRAMADOL 1 AMP in 100ml NS slow IV /ODINJ OPTINEURON 1 AMP in 100ml NS IV/ODINJ MONOCEF 1gm IV/BDINJ AMIKACIN 250mg IV/BDTab PCM 650mg PO/TIDBp/pulse rate/temp  4th hourlyGRBS 6th hourly


Day 3INJ METROGYL 750mg IV/TIDINJ PANTOP 40mg IV ODINJ ZOFER 4mg IV/SOSINJ TRAMADOL 1 AMP in 100ml NS slow IV /ODINJ OPTINEURON 1 AMP in 100ml NS IV/ODINJ MONOCEF 1gm IV/BDINJ AMIKACIN 250mg IV/BDTab PCM 650mg PO/TIDTab LIMCEF PO/ODBp/pulse rate/temp  4th hourlyGRBS 12th hourly


Day 4INJ METROGYL 750mg IV/TIDINJ PANTOP 40mg IV ODINJ ZOFER 4mg IV/SOSINJ TRAMADOL 1 AMP in 100ml NS slow IV /ODINJ OPTINEURON 1 AMP in 100ml NS IV/ODINJ MONOCEF 1gm IV/BDINJ AMIKACIN 250mg IV/BDTab PCM 650mg PO/TIDTab LIMCEF PO/ODBp/pulse rate/temp  4th hourlyGRBS 12th hourly


Day 5INJ METROGYL 750mg IV/TIDINJ PANTOP 40mg IV ODINJ ZOFER 4mg IV/SOSINJ NEOMOL 100ml /IV/SOS IF temp >101°FINJ OPTINEURON 1 AMP in 100ml NS IV/ODINJ MONOCEF 1gm IV/BDINJ AMIKACIN 250mg IV/BDTab PCM 650mg PO/TIDTab LIMCEF PO/ODBp/pulse rate/temp  4th hourlyGRBS 12th hourly


Discharge summary

Discharge date -29/6/21

 TREATING FACULTY

DR.RAKESH BISWAS (HOD)

DR.G VITTAL (INTERN)

Diagnosis

-MULTIPLE LIVER ABCESS

Chief complaints 

   60 year old female came to casualty with chief complaints of fever since 6 days, decreased appetite snice 6 days, pain abdomen since 

H/o of present illness 

  • Patient was apparently asymptomatic 6 days back then she developed fever which is high grade associated with chills,not associated with cold,cough,burning micturition.
  • Appetite decreased not associated with nausea,vomitings,loose stools,constipation, weight loss.
  • Pain abdomen which is diffuse,pricking type ,radiating,aggravated on right lateral position and relieved on sitting.
  • Pt went to miryalaguda care hospital I/V/O fever,decreased appetite on 17/6/21.usg abdomen showed mild hepatomegaly with multiple abcess

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