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:

Ultrasound chest.                                                

Ultrasound abdomen.                                    
                     
On 07/08/21:

HEMOGRAM:


2d echo:
On 08/08/21:

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:

On 14/08/2021:




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


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