Amoebic liver abscess


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K.shirisha

Rollno;60, 

9th semester

 

I’ve been given this case to solve in an attempt to understand the topic of “patient clinical data analysis" to develop my competency in reading and comprehending clinical data including history, clinical findings, investigations, and come up with diagnosis and treatment plan

(All the information have been collabated from patient and her daughter in law)

Case discussion;

(Following is the view of my case) ;

Chief complaints

A 50 year old female patient occupation by paddy field worker . brought to casuality on 11/1/22.(10;30pm).with complaints of abdominal pain and fever since 5 days .shortness of breath since 1 day.


History of present illness;

The patient was apparently asymptomatic 5 days ago. then she had fever with high grade

which was insidious in onset,  gradually progressive.intermittent in nature and associated bwith evening rise of temperature.

Fever was not associated with chills and rigor.and was relieved on taking by medication which was prescribed by local rmp

C/O pain in right hypochondrium and epigastrium since 5days.which was sudden in onset and gradually progressive.radiating to shoulder.it was dull aching type. Aggrevated on working and relieved on restor medication

Since on 11/1/22 abdominal pain was severe with shortness of breath due to which she visited local rmp .and she was referred to our hospital.

C/O shortness of breath since 1day grade -2

C/O loss of appetite since 4days

No history of vomiting,loose stools,weight loss.,chest pain, palpitations,pedal edema

No h/O outside food intake

Past history;

No history of similar complaints inthe past.

She is not a known case of diabetes, hypertension, tuberculosis, asthma and thyroid ,epilepsy disorders

Family history;  insignificant

Personal history;

Appetite;  decreased since 4 days

Diet;     mixed

Bowel and bladder ; regular

Sleep;  adequate

Addictions; occasional toddy drinker

General examination;

The patient is conscious , coherent,cooperative and well oriented to time place person

Pallor ; absent

Icterus ; present ( mild)



Cyanosis; absent

Clubbing ; absent

Lymphadenopathy; absent

Edema ; absent.

Vitals;

Temperature; febrile(99.6° f)


Blood pressure: 120/80 mmHg

Heart rate : 90bpm

Respiratory rate: 22cpm

Spo2: 97%on RA

RBS- ; 85mg/dl

Systemic examination;

Per abdomen ;

Inspection;

Shape; slightly distended


Umbilicus; central

Movements ; normal

No visible pulsations,or engorged veins,no visible peristalsis

Skin over abdomen ; normal

Palpation : 

Tenderness in right hypochondrium and epigastrium,local rise of temperature present

Hepatomegaly present

No splenomegaly

Percussion; 

Liver : dull note heared,liver span ;18cm

No shifting dullness or fluid thrills

Auscultation ; bowel sounds are heared


Respiratory system ;

Inspection; 

Inspection of upper respiratory tract;

Oral cavity ; normal

Nose: no dns,polyp

Pharynx; normal

Lower respiratory tract;

Position of apex beat ; left 5ics 1cm medial to mid clavicular line

Symmetry of chest : symmetrical and elliptical

Movements of chest ; normal

Position of trachea ; midline

Bilateral air entry present

Palpation:

No tenderness over chest wall,no crepitations,no palpable added sounds,no palpable pleural rub

Percussion;

Resonant note heared

Auscultation; normal vesicular breath sounds heared, bilateral  air entry present

Cardiovascular system;

Inspection;
Position of trachea ;midline
No visible pulsations,no raised jvp
Precordial bulge : absent
Shape of chest; bilaterally symmetrical
Apex beat ; left 5th inter costal space1cm medial to mid clavicular line
Palpation; no palpable thrills,parasternal heaves are palpable
Percussion ; 


Auscultation; S1,S2 heart sounds are heared , no added murmurs,

Central nervous system : 
 
Higher mental functions : 
Level of consciousness: normal
Speech : normal
No meningeal signs

Cranial nerves;

1 ) olfactory nerve ; percieves smell

2) optic nerve : normal visual acuity

3) occlomotor nerve ; normal

4) trochlear nerve ;  normal

5) trigeminal nerve ; normal

6) abducens nerve ; normal

7) facial nerve; normal

8) vestibuli cochlear nerve; normal

9) glossopharyngeal nerve; normal

10)vagus nerve ; normal

11) spinal accessory nerve ; normal

12) hypoglossal nerve ; normal

Gait: normal

Motor system ;

Power  U/L         L/L

   Right   5/5        5/5

    Left      5/5        5/5

Tone        U/L                    L/L

Right       normal.        Normal

Left          Normal             Normal 

Reflexes   Biceps triceps supinator knee ankle 



Right             2+             2+            2+      2+.   2+

Left                  2+             2+.          2+.   2+.   2+

Plantar reflex: flexor

Sensory system : normal

Cerebellar signs;

Finger nose in coordination; yes

Knee heel in coordination; yes

Investigations;


On12/1/22;

Serology;

Rapid antigen test: negative

RT PCR

Hemogram;

Hemoglobin ; 11.3g/dl

Total leucocyte count; 30,500cells /cumm

Platelet count ; 2.65 lakhs/cumm

Renal function tests;

Urea- ; 73 mg/ dl

Creatinine : 1.7 mg/ dl

Sodium ; 137

Potassium : 4.2

Chloride ; 95

Liver function tests;

Total bilirubin ; 2.55

Direct bilirubin ; 1.08

SGOT : 41

SGPT : 37

ALP; 1022

Total protein : 5.9

Albumin; 1.72

A/G ratio :0.41

RBS- ;70


ECG ;


Ultrasound; (11/1/22)

Liver; increased size- e/o 9.3×8.8cms

Large heteroechoic lesion in liver parenchyma of right lobe in segments 6and 7 , with no vascularity

( No intervening liver parenchyma between liver capsule and lesion)

* Right mild pleural effusion with air sonograms in the basal lung segments.

Impression;

1) liver abscess with poor liquefaction (15-20%) with hepatomegaly

2) Right mild pleural effusion with consolidatory changes in underlying lung segments.

3)Raised echogenicity of bilateral kidneys.





On12/1/22;

Mild ascites


Provisional diagnosis; Amoebic liver abscess

Treatment ;

1) Inj CEFTRIAXONE 2gm /iv/bd

2) Inj metrogyl 750mg /iv/TID

 8am- 11am- 8pm

3)Inj PAN 40 mg / iv/ od

1-0-0

4) Inj Tramadol 1 amp in 100ml na/ iv / sos

5)Inj zofer 4mg / iv/ bd

1-0-1

6) intravenous fluids - NS, RL, Dns- 100 ml

7) strict intra oral charting

8) Inj neomol 1gm/iv/ sos




https://youtu.be/zhyLkko62no







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