General medicine case 5
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A 40 year old male presented to opd with chief complaints of pain in right loin region and right iliac region since 4 days
Fever since 7 days
1 episode of vomiting before admitted
Cough presents for 20mins at night
Burning micturition slowly since 6 months
HISTORY OF PRESENT ILLNESS :
Patient was apparently asymptomatic 1 week ago later he developed pain which is sudden in onset , dragging type started at loin region shifted to flank and front side
Fever which is sudden in onset , intermittent type , stepladder , associated with chills and rigors and sweating decreased on medication
Vomiting which is non- bilious , non projectile, food as content
Cough which is productive associated with sputum lasted 10min , pain increases with cough
Got daignosed with S.typhi + 2 days back
HISTORY OF PAST ILLNESS:
USG showed hepatomegaly and G7 fatty liver
Not a known case of DM , HTN , Asthma , Epilepsy
PERSONAL HISTORY:
Non vegetarian
Appetite :lost
Sleep is adequate
Bowel and bladder movements irregular since 4 days
Chronic alcoholic since 20years stopped 1 week back . Drinks 250ml per day
Gutka since 20 years (more usage )
Cigarette since 20 years stopped 5 years ago 1 pac daily
FAMILY HISTORY:
No similar complaints in family
GENERAL EXAMINATION:
Patient is conscious , coherent , cooperative , well oriented
No pallor, icterus , cyanosis, lymphadenopathy, pedal edema
Vitals :
Temp: afebrile
PR: 78 bpm
RR: 40cpm
BP: 110/80mmHg
SPO2 : 99%
GRABS: 105 mg%
SYSTEMIC EXAMINATION:
CVS:
S1 S2 heard
No thrills
No cardiac murmurs
RESPIRATORY SYSTEM:
Position of trachea is central
Bilateral air entry is normal
Normal vesicular breath sounds heard
No added sounds
PER ABDOMEN :
Abdomen is soft , tender in right hypochondrial and epigastric region
CNS:
Patient is conscious
Speech is present
No focal deficit
No meningeal signs
PROVISIONAL DAIGNOSIS:
Liver abscess , alcohol and tobacco dependence
INVESTIGATIONS:
Complete blood picture:
Hemoglobin: 12.7 gm/dl
Total count : 12400cells/cumm
Neutrophils: 75%
Lymphocyte: 20%
Eosinophils: 02%
Smear : Normocytic normochromic with leucocytosis
ESR
TREATMENT
DAY1
- inj metrogyl 750mg IV/tid
- inj buscopan 2cc po/od IV
- tab pcm 500mg po/od
- tab ultracet 1/2
DAY 2
- inj metrogyl 750mg IV/tid
- inj buscopan 2cc po/od IV
- tab pcm 500mg po/od
- tab ultracet 1/2
- tab pan 40 mg po/od
DAY 3
- inj metrogyl 750mg IV/tid
- inj buscopan 2cc po/od IV
- tab pcm 500mg po/od
- tab ultracet 1/2
- tab pan 40 mg po/od
- inj Ciprofloxacin 500mg IV od
DAY 4
- inj metrogyl 750mg IV/tid
- tab pcm 650mg po/od
- tab ultracet 1/2
- tab pan 40 mg po/od
- inj Ciprofloxacin 500mg IV od
- syp lactulose 15ml po
- How common is the bacterial disease of liver
- what are the types of liver abscess
- what causes pyogenic liver abscess
- how do infections in organs cause liver abscess
- which conditions are associated with secondary pyogenic liver abscess
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