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A 56 year old male came to the opd with chief complaints of
pain in the right upper quadrant since 2months
Decreased appetite since 2months
Difficulty in passing stools since 2months
Cough since 5days
History of present illness: He was apparently asymptomatic 2months back then he developed pain in the right upper quadrant which is of pricking type , aggravated on inspiration associated with loss of appetite and cough .Cough is productive in nature sputum is blood stained moderate in amount ,mucoid in consistency. No h/o fever; melena
No h/o chest pain ; shortness of breath ; palpitations
No h/o headache ; loss of consciousness; trauma
No h/o vomtings; diarrhoea; vomtings.
Past history: Appendicectomy was done 30yrs back . He has no similar complaints in the past.
Personal history: appetite is normal
He is nonvegetarian ; bowel and bladder movements are regular and he sleeps well.
He is an alcoholic since 20 years ;drinks 2 litres of toddy daily and stopped 2months back. He is a smoker and smokes 4 cigarettes / day and stopped 2months back.
Family history:Not significant
Drug history: Not allergic to any known drugs
Physical examination: patient is conscious, coherent, cooperative ,moderately built and nourished .He has no Pallor ,icterus, cyanosis, clubbing,lymphaedenopathy , edema. His pulse- 72 bom
BP- 100/ 60 mmhg
Respirator rate- 23cpm
Temperature - afebrile
Systemic examination:
GIT:
Per abdomen :
On inspection ; abdomen is normal in shape
Umbilicus is inverted.
On palpation; abdomen is soft
Tenderness felt in the right upper quadrant
On auscultation bowel sounds heard
Provisional diagnosis:
Amoebic liver abscess in segment 6 with greater than 50% liquefaction
Iron deficiency anemia with amoebiasis
Treatment given :
Inj.Ceftriaxone Ivig BD
Inj. Metrogyl 750mg iv tid
Inj. Pantoprazole 40mg iv od
Tab. Orofer p/o od before lunch
Tab. PCM 650mg sos
Tab. Benfomet plus po od before lunch
Tab. Chloroquine 500mg po od after lunch
Syrup. Ascoryl 10ml tid
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