A CASE OF LIVER ABSCESS IN RIGHT LOBE

 

A 45 Y/O MALE WITH FEVER ; DYSPNEA ; BURNING MICTURITION ; PAIN IN ABDOMEN 

UNDER THE GUIDANCE OF Dr Aashitha who has taken the detailed history

This is 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.
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CHIEF COMPLAINTS

Fever since 1 week

Dyspnea since 1 week

Burning micturition since 1 week 

Pain abdomen since 1 week

HISTORY OF PRESENTING ILLNESS

A 45 year man, was apparently asymptomatic 14 years back. 
14 years back during his wife's  pregnancy on routine investigations she was found to be RVD positive. On getting tested, he turned out to be RVD positive as well. 
He was started on medications which he takes regularly ( not documented ), he says he takes 2 tablets at night. And his wife takes one tablet at night. On asking whether their child was also RVD positive, his wife told us that their child's test came out to be negative.

HIS MEDICATIONS( PATIENT) 
PATIENTS  WIFE MEDICATION


1 year back - he experienced pain abdomen in the right lumbar region radiating to his lower back for almost a month. He went to a local hospital and was diagnosed to have a right renal calculi for which he used medications for a couple of days and was advised to consume plenty of water.
Later he never experienced a similar episode.

Since 1 week he has been experiencing high grade fever associated with chills, he says it's more during early morning around 5 am and at midnight around 12 am. He also feels dyspneic whenever he gets these fever spikes.
He also has been experiencing burning micturition since a week along with pain abdomen. His says the pain abdomen he is experiencing is similar to the one he experienced one year back, in his right lumbar region radiating to his lower back.

He visited 2 local hospitals,
In one hospital he even received 
Tab Dexa along with Paracetamol for his fever 
He later visited another hospital where in  he was further evaluated for his symptoms. 

25/7/21 

His ECG shows regular sinus rhythm 
His TLC is around 15k
CUE shows 10 to 12 pus cells
ULTRASOUND  abdomen shows right lower lobe single abscess measuring around 61 * 59 mm with partial liquefaction 
 He was started on Inj piptaz which he received 4 doses. 
Since his fever and burning micturition wasn't subsiding he paid a visit to our hospital this morning.



HISTORY OF PAST ILLNESS

No history of Diabetes mellitus
                    Hypertension
                    Thyroid disease
                    Bronchial  Asthma
                    Tuberculosis
H/O Right Renal Calculi 2 yrs back

PERSONAL HISTORY

Married
Normal appetite
Mixed diet[Non vegetarian]
Bowels regular
Micturition normal
There are no allergies 
Habits: Alcohol occasional

FAMILY HISTORY

No significance

General examination

NO Pallor 

NO Icterus

NO Cyanosis

NO Koilonychia

NO Lymphadenopathy

NO Edema 

NO Malnutrition

VITALS

BP : 100/80 mm/Hg

Pulse rate : 88 /min


SYSTEMIC EXAMINATION 

CVS

S1 and S2 heard +
 

RESPIRATORY SYSTEM

ISA Bilateral crepts +

ABDOMEN

Tenderness in Right Lumbar Region

No palpable mass, fluid , bruits



Bowel sounds are heard

CNS 

Is Conscious

Normal speech

No Signs of meningeal irritation

PROVISIONAL DIAGNOSIS

LIVER ABSCESS IN RIGHT LOBE OF LIVER
[61 * 59 mm Partially liquified Single Abscess]

URINARY TRACT INFECTION

RVD POSITIVE

PLAN OF CARE: Conservative
EXPECTED OUTCOME: Guarded


INVESTIGATIONS

 ECG



HBs-Ag RAPID


Anti HCV Antibodies-RAPID



ULTRASOUND




TREATMENT

Day 1

Liver abscess in right lobe

VITALS 

Temperature:100.6 F

BP :100/60 mm Hg

PR = 75 beats/min REGULAR

CVS = S1 S2 + No murmurs

GRBS : 132 mg/dl

P/A : soft


1] PLENTY OF ORAL FLUIDS 2-3 L/DAY

2] IVF-NS at 75ml/hr

         -RL at 75ml/hr

3]INJ METROGYL 750mg/IV

4]INJ CEFTRIAXONE 1mg/IV

5] INJ PAN 40mg/IV

6] INJ ZOFER 4 mg/IV

7]CONTINUE ART -[LAMIVUDINE 150 mg  AND NEVIRAPINE ]

8] TAB PCM 680 mg/PO

9] INJ THIAMINE 100 mg IN 100 ml /IV

9] BP/PR/TEMPERATURE CHARTING AND HOURLY

10]STRICT I/O CHARTING

11] GRBS CHARTING 8 HOURLY


Day 2

FRESH COMPLAINTS 1 EPISODE OF FEVER SPIKE



VITALS 

BP :110/50 mm Hg

PR = 78 beats/min REGULAR

CVS = S1 S2 + No murmurs

GRBS : 104 mg/dl

P/A : soft


1] PLENTY OF ORAL FLUIDS 2-3 L/DAY

2] IVF-NS at 75ml/hr

         -RL at 75ml/hr

3]INJ METROGYL 750mg/IV

4]INJ CEFTRIAXONE 1mg/IV

5] INJ PAN 40mg/IV

6] INJ ZOFER 4 mg/IV

7]CONTINUE ART -[LAMIVUDINE 150 mg  AND NEVIRAPINE ]

8] TAB PCM 680 mg/PO

9] INJ THIAMINE 100 mg IN 100 ml /IV

9] BP/PR/TEMPERATURE CHARTING AND HOURLY

10]STRICT I/O CHARTING

11] GRBS CHARTING 8 HOURLY


Day 3

FRESH COMPLAINTS 1 EPISODE OF FEVER SPIKE

VITALS 

BP :110/70 mm Hg

PR = 78 beats/min REGULAR

CVS = S1 S2 + No murmurs

GRBS : 249 mg/dl

P/A : soft


1] PLENTY OF ORAL FLUIDS 2-3 L/DAY

2] IVF-NS at 75ml/hr

         -RL at 75ml/hr

3]INJ METROGYL 750mg/IV

4]INJ CEFTRIAXONE 1mg/IV

5] INJ PAN 40mg/IV

6] INJ ZOFER 4 mg/IV

7]CONTINUE ART -[LAMIVUDINE 150 mg  AND NEVIRAPINE ]

8] TAB PCM 680 mg/PO

9] INJ THIAMINE 100 mg IN 100 ml /IV

9] BP/PR/TEMPERATURE CHARTING AND HOURLY

10]STRICT I/O CHARTING

11] GRBS CHARTING 8 HOURLY


Day 4

VITALS 

Temperature: Afebrile

BP :110/70 mm Hg

PR = 78 beats/min REGULAR

CVS = S1 S2 + No murmurs

P/A : soft


1] PLENTY OF ORAL FLUIDS 2-3 L/DAY

2]INJ METROGYL 750mg/IV

3]INJ CEFTRIAXONE 1mg/IV

4] INJ PAN 40mg/IV

5] INJ ZOFER 4 mg/IV

6]CONTINUE ART -[LAMIVUDINE 150 mg  AND NEVIRAPINE ]

7] TAB PCM 680 mg/PO

8] TAB MVT

9] BP/PR/TEMPERATURE CHARTING AND HOURLY

10]STRICT I/O CHARTING

11] GRBS CHARTING 8 HOURLY




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