52M ?AMOEBIC LIVER ABSCESS

TEJASWINI MARISA(INTERN)

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Chief complaints:
Patient with complaints of right sided abdominal pain since 15days
Decreased appetite since 15days
Decreased sleep since 15days
HOPI:
Patient was apparently alright 15days back then he had 2 to 3 episodes of vomitings after binge of alcohol(2 bottles of toddy) developed low grade fever, intermittent, not associated with chils and rigors
No diurnal variation 
No h/o cough, cold, burning micturition, loose stools
H/o vomitings present non projectile,non bilious, food particles as content
Pain abdomen since 15days squeezing type aggravated on bending forward relieved on lying down
Associated with decreased sleep and appetite
Past history -  
N/k/c/o DM, HTN, asthma, TB, epilepsy,CAD, CVD
General examination
Patient is conscious, coherent and cooperative
 pallor present 
No icterus,cyanosis, clubbing, lymadenopathy,Generalised edema
Vitals 
Patient is c/c/c
bp-100/80
Pr -92bpm
Temp:101.1°F
GRBS: 133mg/dl
Systemic examination
Rs-bilateral air entry present 
      Nvbs 
CVS -s1 S2 heard
No murmurs 
P/A -
Inspection:
Scaphoid abdomen
No visible scars, sinuses, engorged veins
All quadrants of abdomen moving equally with respiration
No visible pulsations and peristalsis
Palpation:
No local rise of temperature
tenderness in right hypochondrium 
No other palpable mass
Hernial orifices normal
Percussion:
Resonant note
Auscultation:
Bowel sounds heard
CNS- no FND
INVESTIGATIONS

2D ECHO
ECG


USG CHEST
USG ABDOMEN
CXR




Diagnosis:
? amoebic liver abscess with liquifaction <10% R lower lobe consolidation ?pneumonia With synpneumonic effusion

Treatment:
IV  FLUIDS ns and rl at 75ml/hr
Inj metronidazole 500mg iv/tid
Inj piptaz 4.5g iv/tid
Inj neomol 1g iv/ sos
Inj optineuron 1 amp in 100ml ns/iv/bd
T. Dolo 650 mg po/bd
Inj tramadol 100mg iv/sos

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