General Medicine Blog


26 YEAR OLD MAN WITH AMOEBIC LIVER ABCESS


A 26 yr old man construction worker by occupation came to casuality with the complaints of :
  • Fever since 3 months 
  • Cough since 2 months 
  • Dyspnoea on exertion since 2 months 

History of present illness:

Patient was apparently asymptomatic 3 months back.Then the  Patient narrates consumption of 8 beers then after getting back home he experienced high fever not associated with chills. Then he went to local hospital and  on checking tempearture it was 104 °F for which he received medications for 2 days and the fever subsided and he started his routine activities.
Since 2 months he has been experiencing cough which is productive and blood tinged.
Since 2 months he is also experiencing dyspnoea on exertion .
Associated with vomiting - 3 episodes per day, containing food particles and blood .
Loss of weight of about 10 kg over 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 Dm, htn,asthma, tb , epilepsy

Personal history: 

Diet - mixed
Appetite- normal 
Sleep- adequate 
B& B - regular 
Addictions - He takes alchohol occasionally  .cigarette smoking occasionally

General examination: 

Patient is a thin built man who is conscious , coherant,cooperative. 
Pallor present
Vitals on admission:
Temp: 98.6°F 
PR: 98bpm
RR: 20cpm 
Bp : 110/70 mm of hg 
Spo2 98%at RA 
Grbs: 202mg%

Systemic examination: 
CVS:
S1 S2 present 


RS: 

Inspection: Decreased movements on right side

Palpation:Decreased tactile fremitus

On percussion: dull note in right infrascapular area

On auscultation: 
Decreased breath sounds in rt. ISA ,IAA

Per abdominal examination: Tenderness present in Rt. Hypochondriac and epigastric region 
Bowel sounds present .

CNS:- NAD

Provisional diagnosis:
Amoebic liver abcess 
Haemoptysis secondary to liver abcess
Communicating with bronchi
\
Investigations:
On 26/6/21:

On 24/7/21:

Investigations done in our hospital

On 05/08/2021.    

ECG:                                   


CHEST XRAY : 

SEROLOGY:

HEMOGRAM:

APTT:

PT:

ESR:

BLOOD GROUPING:

BLEEDIND AND CLOTTING TIME:

CUE:

SERUM URIC ACID:


SERUM ELECTROLYTES:

SERUM CREATININE:

LFT:

BLOOD UREA:

RTPCR:

Ultrasound:

Ultrasound chest.                                                


Ultrasound abdomen.                                    

Treatment given:

1.IVF -2 Dns @75ml /hr 
            1 Dns with 1 ampulevof optineurin
2. Inj. Monocef 1gm / iv/BD
3. Inj. Pantop 40 mg iv OD 
4. Inj. Zofer 4mg iv tid 
5. Syp.  Ambroxyl po tid 10ml- 10ml-10ml
6. Tab. Dolo 650mg po sos
7. Inj. Metrogyl 750 ml iv tid

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