A 35 year old man with complaints of Pain abdomen and fever since 5 days

 


A 35 year old man Artist by occupation from Choutuppal came to our hospital with 

C/o Pain abdomen since 5 days and fever since 3 days

History of presenting illness

Patient was apparently asymptomatic 15 days ago. 

He attended a party where he drank heavily and had heavy food, following morning patient developed Pain abdomen in the right hypochondriac region and epigastric region which was insidious in onset and gradually progressive and was associated with fever so he took some medication which subsided pain and fever for few hours. Pain was sudden, pricking type and was radiating to the back. Due to pain he stopped working. 

Couple of days later he visited a hospital at Choutuppal as the pain was increasing where he was told to have Jaundice, Blood and urinary tract infection and was prescribed medication. 

Patient had burning micturition and passed red colored urine for 3 days followed by yellow colored urine for about 5 days

Patient passed dark colored stools for 3-4 days. 

1 week back he lost his appetite and was only having grapes and also couldn't sleep due to pain

5 days back Pain was severe which was again associated with fever so he came to our hospital. 

No aggravating and relieving factors for pain 

No h/o vomiting, chills and rigors, nausea, cough, body pains, diarrhoea. 

 

Past history

No similar complaints in the past 

Not a known case of Diabetes mellitus, Hypertension, Asthma, Epilepsy, Tuberculosis,CAD.

History of operation for Inguinal hernia 10 years back and met with an accident 8 years back for which he got stitches on his scalp


He is unmarried and stays alone by himself as his Father passed away in 2010 due to chronic alcoholism and his mother passed away in 2016 due to breast cancer during this time he got addicted to alcohol and cigarette smoking. 


Personal history

Mixed diet

Appetite reduced since 1 week and patient only had grapes every day

Sleep inadequate since 1 week

Bladder movements regular

Constipated since 5 days as he is not having food

Addicted to alcohol and cigarette smoking since 10 years and smokes 20 cigarettes per day and drinks half bottle alcohol every day

During mornings he experiences tremors while painting which subsides after drinking 90ml of alcohol and also has a habit of continuous smoking during the day while working. 

He stopped smoking 20 days back due to some restrictions in his work place 

He stoped drinking 15 days back when he started experiencing pain abdomen following  heavy drinking. 

No history of drug addiction. 

No allergies

He doesn't drink or smoke or eat Non-vegetaerian  food for a fixed span of 50 days every year because of religious commitment and 10 days following that he has decreased cravings for alcohol and smoking. 


Family history

No significant history


Tolerance present

Tremors present whenever he doesn't consume alcohol

Cravings for alcohol and tobacco present


Psychiatric history

No h/o head injury, seizures

No h/o  low mood, suicidal thoughts

No h/o hearing of voices


Time line




General examination

Concious, Coherent, Cooperative

Well oriented to time, place and person

BP-140/90 mm of Hg

Pulse rate - 90 bpm

Respiratory rate -20 cycles per min

Temperature - 102° F

SpO2-  92%

Pain - intermittent,Pricking type of pain in Right hypochondriac and epigastric region with no aggravating and relieving factor

Icterus present

No Pallor, Cyanosis, clubbing, Lymphadenopathy, Edema. 






Systemic examination

CVS - S1, S2 heard, No murmurs

RS - NVBS +

Abdomen - Tenderness present in Right hypochondriac and epigastric region

No palpable masses

No free fluid in the abdomen

Liver not palpable

Spleen not palpable



Bowel sounds- sluggish

CNS - No focal neurological deficits


Provisional diagnosis

Liver abscess


Investigations

CBP 

 Hb- 12.2 mg/dL

 TLC- 18,500

 Platelets - 4.5 lacs

Serology - Seronegative for HCV, HBsAg, HIV 1 and 2

LFT 

  TB-5. 42

  DB-3. 86

  AST-163

  ALT-139

  ALP-603

  TP-5. 3

   A/b- 2.6

USG -shows 50% liquefaction





Abdomen PA/AP



Treatment

NS and RL

Inj. Metogryl

Inj. Pantop

Inj. Piftaz

Inj. Tramadol

Magnex

Thiamine

Inj. Diclofenac









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