35yr old with Liver Abscess

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 Name:- J. Lohith Varma 

(1st Yr student- MD General Medicine) 

35yr old male, carpenter, came to the medicine OPD with Pain Abdomen 

(Right hypochondriac & Right lumbar Region) 

Since 4 days. 

HISTORY OF PRESENTING ILLNESS:

Patient was apparently  alright 4 days ago then he had developed fever (high grade) associated with chills which relieved on medication, he had also developed Pain Abdomen (Rt.hypochondriac & Rt.lumbar Region) Since 4 days, which was not Radiating. 

No h/o Vomiting and loose stools 

No h/o Pedal oedema, Decreased urine output, 

Shortness of breath 

PAST HISTORY: 

No similar complaints in the past. Patient is not a k/c/o DM,HTN,CVA,CVD,TB,Asthma.

PERSONAL HISTORY: 

Diet is mixed 

Appetite is good 

Sleep is Adequate 

Bowel & Bladder movements are Regular 

No Known allergies 

Patient is a Chronic Alcoholic (180ml/day)

FAMILY HISTORY: 

No significant family history 

GENERAL EXAMINATION:

Patient is conscious, coherent, cooperative. 

Well oriented to time, place and person. Moderately built and moderately nourished. 

There is no pallor, icterus, cyanosis, clubbing, lymphadenopathy and oedema.

Vitals 

BP: 130/80mmHg 

PR: 88 bpm 

Temp: afebrile 

RR: 22 cpm

GRBS: 142mg% 

SYSTEMIC EXAMINATION: 

CVS: S1 S2 present 

No thrills / murmurs 

RS: B/L Air Sounds Heard (Vesicular)

Position of trachea is central 

No dyspnoea / wheeze 

CNS: Patient is conscious

Normal speech 

No neck stiffness 

Glasgow scale 15/15

Reflexes -normal

Per Abdomen: 

Shape -Rounded

Tenderness present in the Rt.Lumbar and art.hypochondriac region 

with no Guarding or Rigidity 

No palpable masses

No free fluids 

No bruits 

Liver and spleen are not plapable 

Bowel sounds present 

INVESTIGATIONS: 

Haemogram: 

Hb-12.6gm/dl

TLC- 15,300 cells/cumm

Neutrophils -65% 

lymphocytes -20% 

monocytes-10%

Eosinophils - 5%

PLT - 4.7 lakhs/cumm

RBC-3.72million/cumm

PCV - 36.7%

MCV-98.7

MCH -33.9

MCHC - 34.3

RDW-CV-12.9

DRW-SD-47.0

CUE

colour - Pale yellow 

Appearance - Clear

Reaction - Acidic 

sp. Gravity - 1.010

Albumin - Trace

Sugar -Nil

Bin salts - Nil

Bile Pigments - Nil

Epithelial cells-2-3 

RBC-Nil

Crystals-Nil 

Casts-Nil 

RFT

B.Urea- 26mg/dl

S.Creatinine - 0.9mg/dl 

LFT

Total bilirubin: 0.74mg/dl

Direct bilirubin: 0.17mg/dl

SGOT:17 IU/L

SGPT: 15IU/L

ALP: 75IU/L

Total proteins:6.6gm/dl

Albumin:3.1gm/dl

A/G ratio: 0.89

Serum Electrolytes 

Sodium- 131 mEq/L

Potassium- 4.3 mEq/L

Chloride - 102 mEq/L

Calcium Ionized 1.06 mmol/L

Phosphorus- 3.4mg/dl 

HbsAg- Negative 

Anti HCV Antibodies- Non Reactive 

Ultrasonography Abdomen: 

• Grade 1 Fatty liver with mild hepatomegaly 
• Evidence of 7*4cm Liver Abscess noted in segment 5 of liver with 10 % liquefaction 
• Normal Right iliac fossa 
• Evidence of few Hyper echoic foci noted in gallbladder, largest with 6-7mm-cholelithiasis 

Review USG 

• Evidence of 7*4cm Liver Abscess noted in segment 5 of liver with 10-20% liquefaction 

DIAGNOSIS:

LIVER ABSCESS in SEGMENT 5

PARTIALLY LIQUEFIED(10%- 20%)

CHOLELITHIASIS 6-7MM

TREATMENT: 

1.   INJ.PIPTAZ 4.5G/IV/TID FOR 6 DAYS
2.   INJ METROGYL 500MG/IV/TID FOR 6 DAYS
3.   IVF - NS/RL @ 100ML/HR IV INFUSION
4.   INJ PANTOP 40MG/ IVIOD
5.   IN ZOFER 4MG/IV/SOS
6.   TAB ULTRACET PO/BD
7.   INJ OPTINEURON 1 AMP IN 100ML NS/IV/OVER 30MINS
8.   SYP.CREMAFFIN POHS 15ML
9.   INJ TRAMADOL 1 AMP IN 100ML NS/IV/OVER 30MINS SOS
10.   TAB OFLOXACIN 400 MG PO BD
11.   TAB METROGYL 500 MG PO TID