1601006039 LONG CASE

LONG CASE  :    

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  A 55 year old Male Farmer by occupation came with complaints of 
1)     Severe pain abdomen since 10 days
2)    Fever since 7days

Chief complaints: 

                            A 55 year old Male ,Farmer by occupation, resident of Miryalguda ,

 came with complaints of :

1) pain abdomen since 10day 

2) Fever since 7 days 

HISTORY OF PRESENTING ILLNESS:

                      Patient was apparently asymptomatic 10 days ago then he  developed 
👉severe pain abdomen in the right upper quadrant  of abdomen ,
➤which was sudden in onset , gradually progressive , dragging type and non radiating pain.
➤It is aggravated on standing position and relieved for sometime upon taking medication.
➤Not associated with nausea, vomiting, loose stools.
 👉then he developed  high grade  fever ,which was continuous  for 1 week and associated with chills and rigor. 

➤It is not associated with Cold,cough, shortness of breath,neck pain,giddiness, headache and sweating.

➤It is relieved on taking medications

-➤No complaints of chestpain, palpitations and burning micturition.

HISTORY OF PAST ILLNESS:

                       Patient was admitted in the hospital for 3 days with similar complaints ,14 days ago and was given IV antibiotics for 3days.
 There is no history of DM/HTN/EPILEPSY/ASTHMA/CVA/CAD.

Treatment history:

A  3 day high dose  antibiotics medication  14days ago
PERSONAL HISTORY:
                       Appetite -decreased since 1 week
                        Bowel and bladder-Regular
                        Micturition-normal
              Addictions- 
toddyconsumption- 1litre/day since 30years
Tobacco in the form of beedi- 10/day since 30years

FAMILY HISTORY: 

There is no relevant family history

General physical examination:

The patient is conscious, coherent and cooperative.
- He is well oriented to time, place and person.
- He is moderately built and moderately nourished.
Vitals:
- Temperature = he is now afebrile




 Pulse = 76 beats per minute, regular, normal in volume and character. There is no radio-radial or radio-femoral delay.
- Blood pressure = 110/80 mm of Hg
- Respiratory rate = 16 cycles per minute.
- JVP is normal
- icterus is seen on sclera
- There is pedal edema  which is Pitting type 
     •progressive in nature 
    • extent up to ankles

There is no  signs of Pallor, Clubbing, Cyanosis, Generalized lymphadenopathy 
Spo2 -96% on room air 
RR- 16 cpm
CVS -S1S2 heard no murmers 
RS-decreased air entry in right infraaxillary and infrascapular region  and bilateral fine crepitations are present in right lower lobe.

Abdomen examination:

INSPECTION
1)SHAPE of the abdomen:  symmetrical

          


PALPATION
2) tenderness in the right upper quadrant of abdomen noticed
 percussion
3)There is no palpable mass and liver span is 11cm.
4) hernial orifices are normal and umbilicus normal
5) There's no free fluid level
6)No bruits heard
7)Liver not palpable
8)spleen not palpable
AUSCULTATION
9)bowel sounds heard on auscultation.

  INVESTIGATIONS              

CBP :      low hbg, normocytic normochromic anemia

               low lymphocyte count 

LFT:  

elevated serum total bilirubin, direct bilirubin, low albumin levels.

CULTURE reports:

 Methicillin sensitive staphylococcus aureus

Plain radiograph of thorax showing right lower pleural effusion

USG : 

     Hetro echoic collections in  right lobe of liver are seen. 

APTT : normal

 PROVISIONAL DIAGNOSIS OF THIS CASE :

 based on the investigations:   liver abscess.

treatment recieved :