A 70 YR OLD MALE WITH LIVER ABSCESS

This is an online E log book to discuss our patient's de-identified health data shared after taking his/her/guardian's signed informed consent. Here we discuss our individual patient's problems through series of inputs from available global online community of experts with an aim to solve those patient's clinical problems with collective current best evidence based inputs. This E log book also reflects my patient-centered online learning portfolio and your valuable inputs on the comment box
patient came with complaints pain abdomen since 2 days
Fever since 10 days
And dribbling of urine since 10 days
Patient was apparently asymptomatic 3 yrs back then he developed low grade fever for days following swelling for scrotum for 3 days insidious and then he went to surgeon ,for which intervention was done later he developed 1 week back insidious and low grade for initial 5 days for which he went local RMP ,fever was not relieved and fever increased from past days which is high grade
And pain abdomen since 2 days
Which is gradual in onset
No H/O burning micturition ,cough, vomitings,loose stools
Not a K/C/O DM,HTN,TB ,ASTHMA,CVD
General examination 
Pt is C/C/C
No pallor,clubbing,cynosis,icterus,lympadenopathy and edema
Temp : 102 F
BP 150 /80 mmHg
PR 120 bpm
RR 30 cpm
Spo2 98 @RA
SYSTEMIC EXAMINATION
CVS :S1 S2 +
Rs: BAE +
CNS: NAD
P/A: soft ,tender at right hypochondrium epigastric  and lumbar region 

INVESTIGATIONS 21/5/22
HB :10.8 
TLC: 16,700
PLT: 2.40 lakhs
Blood group A +ve 
RBS 70mg/dl 
RFT
Urea: 64
Creat :1.5 
Na: 131
K: 3.2 
Cl :95
LFT 
TB:2.65
DB:1.30
SGOT :46
SGPT:36
ALP :421
Tp:46
ALB:2.3

PT 17 SEC
INR 1.2
APTT 35 SEC
ESR 90mm/1st hr

USG 21/5/22
1:Left grade 1 RPD
2:right grade 2 RPD with simple renal cyst
3:Liver abscess
USG INGUINAL SCROTAL REGION
Right chroinc moderate hydrocele
Left moderate hydrocele
2D ECHO
EF 60 percent
Good LV systolic function 
Diastolic dysfunction
ECG
Fever chart


clinical images
PROVISIONAL DIAGNOSIS
LIVER ABSCESS SECONDARY TO PYOGENIC/AMOEBIC
Treatment 
1)IV FLUIDS NS /RL @100ml /hr
2)INJ METROGYL 500mg IV /TID
3)INJ MONOCEF 1 gm IV/ BD
4)INJ.THIAMINE 200mg.IV /OD
5)TAB PCM 65PO mg po /SOS
6)INJ NEOMOL1 gm IV sos if TEMP is >102 F
7)INJ PAN 40 mg IV OD

ICU BED NO 2
21/5/22
Day 1
S
Pain abdomen since 3 days
Fever 

O
Pt is C/C/C
No pallor,cyanosis,icterus ,clubbing,lympadenopathy,and
 Edema
Temp -
Bp_120/60 mmHg
PR 100 bpm
RR 29 cpm
GRBS 102 mg @ 8:00am
CNS _NAD
CVS S1 S2 +
RS
 BAE +
P/A_ tender at  right hypochondrium,epigastric  and  rt lumabaregion
A
LIVER ABSCESS SECONDARY TO PYOGENIC /AMOEBIC
P
1)IV FLUIDS NS  /RL @100ml /hr
2)INJ METROGYL 500mg IV /TID
3)INJ MONOCEF 1 gm IV/ BD
4)TAB PCM 65PO mg po /SOS
5)INJ NEOMOL1 gm IV sos if TEMP is >102 F
6)INJ PAN 40 mg IV OD
7) 4 ht hrly BP and TEMP monitoring



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