AMEBIC liver abscess

52M ?AMOEBIC LIVER ABSCESS

L.Navya pgy1

This is 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 patients clinical problms with collective current best evidence based inputs. This e-log book also reflects my patient centered online learning portfolio and your valuable inputs on comment box is welcome .


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 radiating to right anterior chest and axilla
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 -
rigid , tenderness @ R hypochondrium and epigastrium
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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