A CASE OF LIVER ABSCESS IN RIGHT LOBE

August 01, 2021

CHIEF COMPLAINTS

Fever since 1 week

Dyspnea since 1 week

Burning micturition since 1 week

Pain abdomen since 1 week

HISTORY OF PRESENTING ILLNESS

A 45 year man, was apparently asymptomatic 14 years back.

14 years back during his wife's pregnancy on routine investigations she was found to be RVD positive. On getting tested, he turned out to be RVD positive as well.

He was started on medications which he takes regularly ( not documented ), he says he takes 2 tablets at night. And his wife takes one tablet at night. On asking whether their child was also RVD positive, his wife told us that their child's test came out to be negative.

HIS MEDICATIONS( PATIENT)

PATIENTS WIFE MEDICATION

1 year back - he experienced pain abdomen in the right lumbar region radiating to his lower back for almost a month. He went to a local hospital and was diagnosed to have a right renal calculi for which he used medications for a couple of days and was advised to consume plenty of water.

Later he never experienced a similar episode.

Since 1 week he has been experiencing high grade fever associated with chills, he says it's more during early morning around 5 am and at midnight around 12 am. He also feels dyspneic whenever he gets these fever spikes.

He also has been experiencing burning micturition since a week along with pain abdomen. His says the pain abdomen he is experiencing is similar to the one he experienced one year back, in his right lumbar region radiating to his lower back.

He visited 2 local hospitals,

In one hospital he even received

Tab Dexa along with Paracetamol for his fever

He later visited another hospital where in he was further evaluated for his symptoms.

25/7/21

His ECG shows regular sinus rhythm

His TLC is around 15k

CUE shows 10 to 12 pus cells

ULTRASOUND abdomen shows right lower lobe single abscess measuring around 61 * 59 mm with partial liquefaction

He was started on Inj piptaz which he received 4 doses.

Since his fever and burning micturition wasn't subsiding he paid a visit to our hospital this morning.

HISTORY OF PAST ILLNESS

No history of Diabetes mellitus
Hypertension
Thyroid disease
Bronchial Asthma
Tuberculosis
H/O Right Renal Calculi 2 yrs back

PERSONAL HISTORY
Married
Normal appetite
Mixed diet[Non vegetarian]
Bowels regular
Micturition normal
There are no allergies
Habits: Alcohol occasional
FAMILY HISTORY
No significance
General examination
NO Pallor
NO Icterus
NO Cyanosis
NO Koilonychia
NO Lymphadenopathy
NO Edema
NO Malnutrition
VITALS
BP : 100/80 mm/Hg
Pulse rate : 88 /min

SYSTEMIC EXAMINATION
CVS
S1 and S2 heard +

RESPIRATORY SYSTEM
ISA Bilateral crepts +
ABDOMEN
Tenderness in Right Lumbar Region
No palpable mass, fluid , bruits

Bowel sounds are heard
CNS
Conscious
Normal speech
No Signs of meningeal irritation
PROVISIONAL DIAGNOSIS

LIVER ABSCESS IN RIGHT LOBE OF LIVER
[61 * 59 mm Partially liquified Single Abscess]

URINARY TRACT INFECTION

RVD POSITIVE

PLAN OF CARE: Conservative
EXPECTED OUTCOME: Guarded

INVESTIGATIONS

ECG

HBs-Ag RAPID

Anti HCV Antibodies-RAPID

ULTRASOUND
ULTRASOUND

TREATMENT

Day 1
Liver abscess in right lobe
VITALS
Temperature:100.6 F
BP :100/60 mm Hg
PR = 75 beats/min REGULAR
CVS = S1 S2 + No murmurs
GRBS : 132 mg/dl
P/A : soft

1] PLENTY OF ORAL FLUIDS 2-3 L/DAY
2] IVF-NS at 75ml/hr
-RL at 75ml/hr
3]INJ METROGYL 750mg/IV
4]INJ CEFTRIAXONE 1mg/IV
5] INJ PAN 40mg/IV
6] INJ ZOFER 4 mg/IV
7]CONTINUE ART -[LAMIVUDINE 150 mg AND NEVIRAPINE ]
8] TAB PCM 680 mg/PO
9] INJ THIAMINE 100 mg IN 100 ml /IV
9] BP/PR/TEMPERATURE CHARTING AND HOURLY
10]STRICT I/O CHARTING
11] GRBS CHARTING 8 HOURLY

Day 2
FRESH COMPLAINTS 1 EPISODE OF FEVER SPIKE

VITALS
BP :110/50 mm Hg
PR = 78 beats/min REGULAR
CVS = S1 S2 + No murmurs
GRBS : 104 mg/dl
P/A : soft

1] PLENTY OF ORAL FLUIDS 2-3 L/DAY
2] IVF-NS at 75ml/hr
-RL at 75ml/hr
3]INJ METROGYL 750mg/IV
4]INJ CEFTRIAXONE 1mg/IV
5] INJ PAN 40mg/IV
6] INJ ZOFER 4 mg/IV
7]CONTINUE ART -[LAMIVUDINE 150 mg AND NEVIRAPINE ]
8] TAB PCM 680 mg/PO
9] INJ THIAMINE 100 mg IN 100 ml /IV
9] BP/PR/TEMPERATURE CHARTING AND HOURLY
10]STRICT I/O CHARTING
11] GRBS CHARTING 8 HOURLY

Day 3
FRESH COMPLAINTS 1 EPISODE OF FEVER SPIKE
VITALS
BP :110/70 mm Hg
PR = 78 beats/min REGULAR
CVS = S1 S2 + No murmurs
GRBS : 249 mg/dl
P/A : soft

1] PLENTY OF ORAL FLUIDS 2-3 L/DAY
2] IVF-NS at 75ml/hr
-RL at 75ml/hr
3]INJ METROGYL 750mg/IV
4]INJ CEFTRIAXONE 1mg/IV
5] INJ PAN 40mg/IV
6] INJ ZOFER 4 mg/IV
7]CONTINUE ART -[LAMIVUDINE 150 mg AND NEVIRAPINE ]
8] TAB PCM 680 mg/PO
9] INJ THIAMINE 100 mg IN 100 ml /IV
9] BP/PR/TEMPERATURE CHARTING AND HOURLY
10]STRICT I/O CHARTING
11] GRBS CHARTING 8 HOURLY
Day 4
VITALS
Temperature: Afebrile
BP :110/70 mm Hg
PR = 78 beats/min REGULAR
CVS = S1 S2 + No murmurs
P/A : soft

1] PLENTY OF ORAL FLUIDS 2-3 L/DAY
2]INJ METROGYL 750mg/IV
3]INJ CEFTRIAXONE 1mg/IV
4] INJ PAN 40mg/IV
5] INJ ZOFER 4 mg/IV
6]CONTINUE ART -[LAMIVUDINE 150 mg AND NEVIRAPINE ]
7] TAB PCM 680 mg/PO
8] TAB MVT
9] BP/PR/TEMPERATURE CHARTING AND HOURLY
10]STRICT I/O CHARTING
11] GRBS CHARTING 8 HOURLY