Short case hall ticket no 1601006174

 A 61 year old male came to OPD with chief complaints of pain in abdomen since 10 days , distension of abdomen since 10 days , fever since 2 days. 

 History of presenting illness: 

Pain is diffuse, progressive, dragging type  and is relieved by sleeping sideways. 

 abdominal distension associated with edema of legs(pitting type)

fever since 2 days low grade continuous associated with chills and rigor.

 General examination : 

 Presence of icterus 

 Presence of pedal edema 

Abdominal Examination : 

Inspection: 

Abdomen is symmetrically distended with full flanks 

Umbilicus is everted with slight horizontal slit 

 Abdominal girth is 84cms

 

Palpation:

Superficial palpation: Localised tenderness in the right hypochondrium

Deep palpation: liver is tender, smooth,firm,regular margins, moving with respiration , not able to insuate fingers under the coastal margin.

Percussion : 

Liver span:16 cms 

No shifting dullness

Investigations: 

1. Complete blood picture

2.LFT

Provisional diagnosis: Multiple  pyogenic liver abscess

Treatment: 

inj meropenem500mg i.v BD

Inj Metrogyll750mgi.v  Tid 

Tab doxycycline100mg oraltwice daily

Tab lasix 40mg orally once daily

Syrup lactulose 15ml orally