General medicine case 1

Date of admission: 05/08/2021

26 year old man who is a daily wage worker came to causality with the cheif complaints of fever since 3months,cough since 2 months,dysponea on excretion since 2months  

History of present illness:

Patient was apparently asymptomatic 3 months back. Patient had a habit of consumption of 8 beers  after getting back home he experienced high fever. Then he went to local hospital and  on checking tempearture it was 104 °F for which he received medications for 2 days.  
Since 2 months he has been experiencing cough and  dyspnoea on exertion .
Associated with vomiting - 3 episodes per day, containing food particles and blood .
Loss of weight since  2 months 
Loss of appetite since 2 months 
Dark stool since 3 weeks 
Patient visited 4 hospitals but was not relieved from his symptoms .  

Past history : 

No h/o similar complaints in the past .
No h/o Diabetes mellitus 
No h/o astama
No h/o hypertension
No h/o tb , epilepsy

Personal history: 

Diet - mixed
Appetite- normal
Sleep- adequate 
Bladder and bowel movements- regular 
Addictions - He has habits of alchohol and smoking occasionally. 

Family history:
  No history of similar complaints in family .

Drug history:
   No allergy to known drugs. 

General examination. 
  Patient is conscious,coherent and cooperative. 
Pallor present 
No signs of cyanosis 
No lymphadenopathy
Malnutrition is present 
No clubbing 
No edema 
No icterus 

Vitals:-
Temperature:-98.6°F
Bp:-110/70mm/hg
Pulse rate:-98bpm
Respiratory rate:-20Cpm

Systemic examination:-
 Cardiovascular system
S1 ad s2 sounds are heard 

  Respiratory system :
Position of trachea-normal
Bilateral air entery is normal
Normal vesicular breath sounds-heard 
No added sounds. 

Per abdomen:
Abdomen is distended,hard and tender in epigastric,Right hypochondriac region.

Bowel sounds heard.

CNS
Patient is conscious.
Speech is present. 
Reflexs are normal .

 Provisional diagnosis:
  Liver abscess?
  Cirrhosis of liver?

 INVESTIGATIONS :
   Serology :
  



Hemogram:

APTT:

PT:

Blood grouping:

ESR:

Bleeding and clotting time:

LFT:
Serum uric acid:

Serum electrolytes:



Serum creatinine:

Blood urea:
ECG:


Ultrasound abdomen:


Final diagnosis:
     Liver mass

Treatment:

Day 1 

IVF ( 20 NS @ 75ml/ hr)      

IVF  1 amp Optineuron

Inj Augmentin  1.2g/ IV / BD 

Inj  Pantop 40mg IV /OD 

Inj Zofer 4mg IV /TID 

Tab Dolo 650 mg ( SOS) 

Syp Ambroxyl 10 ml ,TID 

Day 2 

Inj Metrogyl  TID

Inj  Zofer ,TID

IV fluid -NS ,TID 

Inj monocef  1g /BD 

Syp Ambroxyl 10 ml ,TID 

Day 3 & 4 

Inj monocef  1g BD 

Inj  zofer 4mg/IV TID 

Inj  Pantop 40mg IV /OD

Inj 1 amp Optineuron IV/ OD

Inj Metrogyl 100ml /IV  TID 

Tab .Dolo 650mg (SOS) 

Tab.Paromomycin 500mg

Day 5

Inj.metrogyl 750mg iv tid  

Inj monocef  1g BD 

 Inj  zofer 4mg/IV TID 

Inj  Pantop 40mg IV /OD

Inj 1 amp Optineuron IV/ OD

Tab.Diloxinide furoate 500mg po tid

Tab.ultracet 1/2 tab pro Qid

 

Questions 

  1.What are the complications of liver abscess?


  2. What happens if a liver abscess bursts?

   

   3. How long does a liver abscess take to drain?


    


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