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 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 since 3 days. 

HISTORY OF PRESENTING 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


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


SYSTEMIC EXAMINATION 


  • Abdominal examination 

 Inspection

  • Shape -scaphoid
  • Umblicus-inverted
  • Equal movements in all quadrants
  • No visible pulsation,dilated veins,localized swellings

Palpation

  1. Local rise of temperature in right hypochondrium
  2. Tenderness in epigastrium and right hypochondrium 
  3. Guarding and rigidity in epigastrium and right hypochindrium
  4. Mild enlargement of liver

Percussion 

  1. Uppet border of liver is 
  2. Liver span
  3. 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 -NAD


PROVISIONAL DIAGNOSIS:

  • Multiple liver abcess


INVESTIGATIONS :
















































































TREATMENT

Day 1

  1. Iv fluids -NS,RL,DNS @75ml/hr
  2. INJ METROGYL 750mg IV/TID
  3. INJ PANTOP 40mg IV OD
  4. INJ ZOFER 4mg IV/SOS
  5. INJ TRAMADOL 1 AMP in 100ml NS slow IV /OD
  6. INJ OPTINEURON 1 AMP in 100ml NS IV/OD
  7. Tab PCM 650mg PO/TID
  8. Bp/pulse rate/temp  4th hourly
  9. GRBS 6th hourly


Day 2

  1. Iv fluids -NS,RL,DNS @75ml/hr
  2. INJ METROGYL 750mg IV/TID
  3. INJ PANTOP 40mg IV OD
  4. INJ ZOFER 4mg IV/SOS
  5. INJ TRAMADOL 1 AMP in 100ml NS slow IV /OD
  6. INJ OPTINEURON 1 AMP in 100ml NS IV/OD
  7. INJ MONOCEF 1gm IV/BD
  8. INJ AMIKACIN 250mg IV/BD
  9. Tab PCM 650mg PO/TID
  10. Bp/pulse rate/temp  4th hourly
  11. GRBS 6th hourly


Day 3

  1. INJ METROGYL 750mg IV/TID
  2. INJ PANTOP 40mg IV OD
  3. INJ ZOFER 4mg IV/SOS
  4. INJ TRAMADOL 1 AMP in 100ml NS slow IV /OD
  5. INJ OPTINEURON 1 AMP in 100ml NS IV/OD
  6. INJ MONOCEF 1gm IV/BD
  7. INJ AMIKACIN 250mg IV/BD
  8. Tab PCM 650mg PO/TID
  9. Tab LIMCEF PO/OD
  10. Bp/pulse rate/temp  4th hourly
  11. GRBS 12th hourly


Day 4

  1. INJ METROGYL 750mg IV/TID
  2. INJ PANTOP 40mg IV OD
  3. INJ ZOFER 4mg IV/SOS
  4. INJ TRAMADOL 1 AMP in 100ml NS slow IV /OD
  5. INJ OPTINEURON 1 AMP in 100ml NS IV/OD
  6. INJ MONOCEF 1gm IV/BD
  7. INJ AMIKACIN 250mg IV/BD
  8. Tab PCM 650mg PO/TID
  9. Tab LIMCEF PO/OD
  10. Bp/pulse rate/temp  4th hourly
  11. GRBS 12th hourly


Day 5

  1. INJ METROGYL 750mg IV/TID
  2. INJ PANTOP 40mg IV OD
  3. INJ ZOFER 4mg IV/SOS
  4. INJ NEOMOL 100ml /IV/SOS IF temp >101°F
  5. INJ OPTINEURON 1 AMP in 100ml NS IV/OD
  6. INJ MONOCEF 1gm IV/BD
  7. INJ AMIKACIN 250mg IV/BD
  8. Tab PCM 650mg PO/TID
  9. Tab LIMCEF PO/OD
  10. Bp/pulse rate/temp  4th hourly
  11. GRBS 12th hourly


DISCHARGE SUMMARY :

Discharge date -29/6/21

 TREATING FACULTY

DR.RAKESH BISWAS[HOD]

DR.SAI VITTAL[INTERN]

DR.ROOPA[INTERN]

DR.SHIVANI[INTERN]

DR.PREETHI[INTERN]

DR.DEEKSHITHA[INTERN]

DR.RISHIK[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 3 days. 

HISTORY OF PRESENTING 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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