26 year old man with Amoebic liver Abcess
Date of admission: 05/08/2021
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:
On 06/08/2021
CECT:
Ultrasound chest.
Ultrasound abdomen.
On 07/08/21:
HEMOGRAM:
HEMOGRAM:
On 09/ 08/21:
C- Reactive protein:
Fever chart:
0n 10/08/21:
Urine C & S:
Blood C & S:
On 11/08/2021:
Stool for occult blood:
Hemogram:
Treatment given:
On Day 1:
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
On Day 2:
1. Inj. Metrogyl 750 ml iv tid
2. Inj Monocef 1 gm iv BD
3. Inj. Pantop 4o mg iv OD
4. Inj. Zofer 4 mg iv tid
5. Sup. Ambroxyl po tid 5ml- 5ml- 5ml
6. Tab. Dolo 650 mg po sos
7. Tab . paramomycin 500 mg po tid
On Day 3:
1. Inj. Metrogyl 750 ml iv tid
2. Inj . Monocef 1 gm iv BD
3. Inj . Pantop 40 mg iv OD
4. Inj. Zofer 4 mg iv tid
5. Syp. Ambroxyl po tid 10ml
6. Tab. Dolo 650 mg po sos
7. Tab. Diloxinide furoate 500 mg po tid
On Day 4:
1. Inj. Metrogyl 750 ml iv tid
2. Inj . Monocef 1 gm iv BD
3. Inj . Pantop 40 mg iv OD
4. Inj. Zofer 4 mg iv tid
5. Syp. Ambroxyl po tid 10ml
6. Tab. Dolo 650 mg po sos
7. Tab. Diloxinide furoate 500 mg po tid
On Day 5:
1. Inj. Metrogyl 750 mg iv tid
2. Inj . Monocef 1 gm iv BD
3. Inj . Pantop 40 mg iv OD
4. Inj. Zofer 4 mg iv sos
5. Syp. Ambroxyl po tid 10ml
6. Inj. Buscopan 1 amp IV OD
7. Tab. Diloxinide furoate 500 mg po tid
8. Tab. Ultracet 1/2tab po Qid
On Day 6:
1. Inj. Metrogyl 750 ml iv tid
2. Inj . Monocef 1 gm iv BD
3. Inj . Pantop 40 mg iv OD
4. Inj. Zofer 4 mg iv sos
5. Syp. Ambroxyl po tid 10ml
6. Inj. Buscopan 1 amp IV OD
7. Tab. Diloxinide furoate 500 mg po tid
8. Tab. Ultracet 1/2tab po Qid
On Day 7:
1. Inj. Metrogyl 750 ml iv tid
2. Inj . Monocef 1 gm iv BD
3. Inj . Pantop 40 mg iv OD
4. Inj. Zofer 4 mg iv BD
5. Syp. Ambroxyl po tid 10ml
6. Inj. Buscopan 1 amp IV OD
7. Tab. Diloxinide furoate 500 mg po tid
8. Tab. Ultracet 1/2tab po Qid
On Day 8:
1.Inj. Metrogyl 750 ml iv tid
2. Inj . Monocef 1 gm iv BD
3. Inj . Pantop 40 mg iv OD
4. Inj. Zofer 4 mg iv BD
5. Syp. Ambroxyl po tid 10ml
6. Inj. Buscopan 1 amp IV OD
7. Tab. Diloxinide furoate 500 mg po tid
8. Tab. Ultracet 1/2tab po Qid
On Day 9 :
1.Inj. Metrogyl 750 ml iv tid
2. Inj . Monocef 1 gm iv BD
3. Inj . Pantop 40 mg iv OD
4. Inj. Zofer 4 mg iv BD
5. Syp. Ambroxyl po tid 10ml
6. Inj. Buscopan 1 amp IV OD
7. Tab. Diloxinide furoate 500 mg po tid
8. Tab. Ultracet 1/2tab po Qid