A CASE OF HEPATIC ABSCESS PRESENTED IN SUMMER 2021
- The following E-log aims at discussing our patient de-identified health data shared after taking the guardian's signed 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-log also reflects my patient's centered 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 providing treatment best to our skills and wisdom.
A 60 years old female presented in the casualty with complaints of chill associated fever and abdominal pain.
CHIEF COMPLAINTs
➤Fever for the past 6 days.
➤Decreased appetite for the past 6 days.
➤Pain abdomen for the past 3 days.
HISTORY OF PRESENTING ILLNESS
Patient was apparently asymptomatic 6 days ago after which she developed high grade fever associated with chills, but not associated with cold, cough and burning micturition.
6 days before patient developed decrease in appetite which was not associated with nausea,vomiting,diarrhoea,constipation and weight loss.
Pain abdomen which is diffused, radiating and pricking type which gets aggravated on right lateral position and patient gets relieved in sitting posture.
Patient visited nearby hospital in the view of above complaints.
USG Abdomen was done there.
IMPRESSION :- Mild hepatomegaly with multiple abscess .
HISTORY OF PAST ILLNESS
➤Not a known case of hypertension,diabetes,bronchial asthma,epilepsy.
➤k/c/o tuberculosis
DRUG HISTORY
➤No significant drug history.
PERSONAL HISTORY
➤Occupation: Daily waged labor working in Cotton fields.
➤Patient is married
➤Patient takes mixed diet but has a decreased appetite.
➤Bowel and bladder movement is normal and regular.
➤Intake of Alcohol
(180 ml twice a week).
FAMILY HISTORY
➤No significant family history.
ALLERGIC HISTORY
➤No significant allergic history
GENERAL EXAMINATION
➤Pallor : Not seen
➤Icterus : Not seen
➤Cyanosis : Not seen
➤Clubbing : Not seen
➤Lymphadenopathy : Not seen
➤Edema : Not seen
VITALS
➤Temperature : 101℉
➤PR : 108 beats per minute
➤BP : 100/70 mmHg
➤RR : 24 cycles per minute
➤SpO2 : 95% in room air
➤Blood Sugar (random) : 100mg/dl
SYSTEMIC EXAMINATION
ABDOMINAL EXAMINATION
INSPECTION
➤Shape - Scaphoid
➤Umbilicus - Inverted
➤Equal movements in all the quadrants.
➤No visible pulsation, dilated veins and localized swellings.
PALPATION
➤Local rise of temperature in right hypochondrium.
➤Tenderness in epigastrium and right hypochondrium.
➤Guarding and rigidity in epigastrium and right hypochondrium.
➤Mild enlargement of liver.
PERCUSSION
➤Fluid thrill and shifting dullness absent
AUSCULTATION
➤Auscultatory findings are normal.
CARDIOVASCULAR SYSTEM EXAMINATION
➤s1 and s2 heard
➤Thrills absent.,
➤No cardiac murmurs
RESPIRATORY SYSTEM
➤Normal vesicular breath sounds heard.
➤Bilateral air entry present
CENTRAL NERVOUS SYSTEM EXAMINATION
➤Conscious and coherent
PROVISIONAL DIAGNOSIS : MULTIPLE LIVER ABSCESS
INVESTIGATIONS :
DAY 1
USG ABDOMEN
 | ||||||
| USG REPORT IMPRESSION-Multiple liver abscess raised echogenicity of bilateral kidney CT SCAN    DAY 2
|
 |
| ➤COMPLETE URINE EXAMINATION |
 |
| APTT TEST:NORMAL |
 |
| ➤Prothrombin time is normal. |
 |
| CBC-REDUCED HB-9.7gm/dl TOTATL COUNT-13,900cells/cmm |
 | |
➤BACTERIAL CULTURE REPORT IS NORMAL
  LFT(ELEVATED LEVELS) TOTAL BILIRUBIN-2.45mg/dl DIRECT BILIRUBIN-1.89mg/dl ALBUMIN-2.5gm/dl |
DAY 3
 |
➤ESR LEVEL IS HIGHLY ELEVATED - 110mm/1st hour |
 |
| LIVER ABSCESS |
DAY 4
 |
| REDUCED LEVEL OF ELECTROLYTE |
DAY 6
 |
| REVIEW USG-45-55% LIQUEFACTION |
DAY 7
 |
XRAY CHEST-POST TB CHANGES |
DAY 10
 |
| ABDOMEN XRAY TOTAL COUNT-13300cells/cmm  |
 |
| ESR HIGHLY ELEVATED-120mm/1st hour |
 |
| REVIEW USG-MULTIPLE LIVER ABSCESS LIQUEFACTION RANGING FROM 45-55% |
 |
| COLOUR DOPPLER 2D ECHO |
DAY 1
1) IV fluids -NS,RL,DNS @ 75 ml per hour
2) Inj. METROGYL 750 mg IV / TID
3) Inj. PANTOP 40 mg IV OD
4) Inj. ZOFER 4 mg IV/SOS
5) Inj. TRAMADOL 1 AMP in 100 ml NS slow IV /OD
6) Inj. OPTINEURON 1 AMP in 100 ml NS IV/OD
7) Tab. PARACETAMOL 650 mg PO/TID
8) BP / pulse rate / Body temperature monitoring 4th hourly regularly
9) GRBS monitoring 6th hourly regularly
10) Inj. MONOCEF 1gm IV/BD
11) Inj. AMIKACIN 250 mg IV/BD
DAY 2
1) Iv fluids -NS,RL,DNS @ 75ml per hour
2) Inj. METROGYL 750 mg 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 / Body temperature monitoring 4th hourly regularly.
11) GRBS monitoring 6th hourly regularly.
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 / Body temperature monitoring 4th hourly regularly.
11) GRBS monitoring 6th hourly regularly.
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 / Body temperature monitoring 4th hourly regularly.
11) GRBS monitoring 6th hourly regularly.
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 500mg PO/TID
9) Tab LIMCEF PO/OD
10) BP / pulse rate / Body temperature monitoring 4th hourly regularly.
11)GRBS monitoring 6th hourly regularly.
CHIEF COMPLAINTs
➤Fever for the past 6 days.
➤Decreased appetite for the past 6 days.
➤Pain abdomen for the past 3 days.
HISTORY OF PRESENTING ILLNESS
Patient was apparently asymptomatic 6 days ago after which she developed high grade fever associated with chills, but not associated with cold, cough and burning micturition.
6 days before patient developed decrease in appetite which was not associated with nausea,vomiting,diarrhoea,constipation and weight loss.
Pain abdomen which is diffused, radiating and pricking type which gets aggravated on right lateral position and patient gets relieved in sitting posture.
Patient visited nearby hospital in the view of above complaints.
USG Abdomen was done there.
IMPRESSION :- Mild hepatomegaly with multiple abscess .
HISTORY OF PAST ILLNESS
➤Not a known case of hypertension,diabetes,bronchial asthma,epilepsy.
➤k/c/o tuberculosis
DRUG HISTORY
➤No significant drug history.
PERSONAL HISTORY
➤Patient is married.
➤Patient takes mixed diet but has a decreased appetite.
➤Bowel and bladder movement is normal and regular.
➤Intake of Alcohol
(180 ml twice a week).
FAMILY HISTORY
➤No significant family history.
ALLERGIC HISTORY
➤No significant allergic history
GENERAL EXAMINATION
➤Pallor : Not seen
➤Icterus : Not seen
➤Cyanosis : Not seen
➤Clubbing : Not seen
➤Lymphadenopathy : Not seen
➤Edema : Not seen
VITALS
➤Temperature : 101℉
➤PR : 108 beats per minute
➤BP : 100/70 mmHg
➤RR : 24 cycles per minute
➤SpO2 : 95% in room air
➤Blood Sugar (random) : 100mg/dl
SYSTEMIC EXAMINATION
ABDOMINAL EXAMINATION
INSPECTION
➤Shape - Scaphoid
➤Umbilicus - Inverted
➤Equal movements in all the quadrants.
➤No visible pulsation, dilated veins and localized swellings.
PALPATION
➤Local rise of temperature in right hypochondrium.
➤Tenderness in epigastrium and right hypochondrium.
➤Guarding and rigidity in epigastrium and right hypochondrium.
➤Mild enlargement of liver.
PERCUSSION
➤Fluid thrill and shifting dullness absent
AUSCULTATION
➤Auscultatory findings are normal.
CARDIOVASCULAR SYSTEM EXAMINATION
➤s1 and s2 heard
➤Thrills absent.,
➤No cardiac murmurs
RESPIRATORY SYSTEM
➤Normal vesicular breath sounds heard.
➤Bilateral air entry present
CENTRAL NERVOUS SYSTEM EXAMINATION
➤Conscious and coherent
PROVISIONAL DIAGNOSIS : MULTIPLE LIVER ABSCESS
DAY 1
1) IV fluids -NS,RL,DNS @ 75 ml per hour
2) Inj. METROGYL 750 mg IV / TID
3) Inj. PANTOP 40 mg IV OD
4) Inj. ZOFER 4 mg IV/SOS
5) Inj. TRAMADOL 1 AMP in 100 ml NS slow IV /OD
6) Inj. OPTINEURON 1 AMP in 100 ml NS IV/OD
7) Tab. PARACETAMOL 650 mg PO/TID
8) BP / pulse rate / Body temperature monitoring 4th hourly regularly
9) GRBS monitoring 6th hourly regularly
10) Inj. MONOCEF 1gm IV/BD
11) Inj. AMIKACIN 250 mg IV/BD
DAY 2
1) Iv fluids -NS,RL,DNS @ 75ml per hour
2) Inj. METROGYL 750 mg 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 / Body temperature monitoring 4th hourly regularly.
11) GRBS monitoring 6th hourly regularly.
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 / Body temperature monitoring 4th hourly regularly.
11) GRBS monitoring 6th hourly regularly.
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 / Body temperature monitoring 4th hourly regularly.
11) GRBS monitoring 6th hourly regularly.
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 500mg PO/TID
9) Tab LIMCEF PO/OD
10) BP / pulse rate / Body temperature monitoring 4th hourly regularly.
11)GRBS monitoring 6th hourly regularly.
Comments
Post a Comment