73yr old male c/o fever &Pain abdomen since 1week

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Here is a case i have seen:

73 year old male resident of Nakrekal came with complaints of fever and pain abdomen since one week.  

patient was apparently asymptomatic one week back    then developed fever which was gradual on onset high-grade associated with chills and rigors present throughout the day , subsided on taking medication , patient complains of pain abdomen 

( right hypochondrium ) ,

 continuous type ,

not associated with vomitings subsiding on taking medications for few hours. 

History of loose stools 4 -5 episodes watery consistency @ 4 days back . 

History of fall 10 days back due to giddiness .

Complaints of headache diffuse type not associated with blurring of vision or  vomitings ,complaints of loss of appetite since one week ,complaints of generalized weakness since one week , patient observed weight loss since 1 month , history of medication taken for tuberculosis 10 years back not a known case of hypertension or diabetes , alcoholic since 55 years 90ml Per day ,  known case of smoker @ Chutta since 60 years one per day , 

no complaints of burning micturition ,constipation ,cold ,cough night sweats or diarrhoea.          

On examination: 

Patient is conscious, coherent and co operative 

BP- 90/80mmhg 

PR- 80Bpm regular 

CVS - S1S2 heard no murmurs 

RS- Decreased breath sounds in both infrascapular areas. 

P/A - guarding rigidity + 

Temp- 98.6F

Passed stools. 

clubbing is present,

USG abdomen:suggestive of large liver abscess extending into both lobes of liver.

Day1:

Day 2:

Review Usg abdomen done on 10/01/2021

Day3

Review Usg abdomen done

http://pacs.kaminenihospitals.com:99/WADO/MetaData?aet=AEKIMS&studyUID=1.2.392.200036.9116.2.6.1.3268.2051739142.1610505211.301452&sessionKey=16c6e01f-a9ef-444d-a6df-fe3ce64884d6&src=Vijaya

Chest Xray 

On aspiration done on date 9/01/2021

This sample has been sent for culture.

https://www.ncbi.nlm.nih.gov/books/NBK6955/

Provisional Diagnosis-

?PYOGENIC LIVER ABCESS

?AMOEBIC LIVER ABCESS

Treatment given;

Inj.Ciprofloxacin 500mg IV/BD

Inj.Metronidazole 750mg IV/BD

Inj.Pan 40mg IV/BD

Inj.Zofer 4mg IV/TID

IVF-DNS,RL @75ml/hr 

      1ampule optineuron

Inj.Thiamine 100mg in 100ml NS IV/BD

Inj.Tremadol 1amp in 100ml NS IV/BD

Inj.Buscopan 1amp IV/BD

Tab.PCM 650mg /SO's

Strict I/O charting

GRBS 8th hourly

Temperature hourly charting

Encourage pt for adequate oral fluids.