A 42 YEAR OLD MALE ,FARMER,WITH RIGHT SIDED PLEURAL EFFUSION WITH LIVER ABCESS

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is a case i have seen:

A 42 year old male,farmer by occupation,from vellemla village, presented to the opd with the chief complaints of

fever since 45 days

shortness of breath since 5 days

chest pain since 5 days

cough since 2 days

patients was apparently asymptomatic 45 days back ,then he developed fever ,it was high grade associated with chills and rigors ,it is on and off ,he went to outside hospital 45 days back (? typhoid) ,releved on medication.

then he developed shortness of breath from past 5 days ,it is grade  II  to III , shortness of breath not associated with palpitation,pedal edema,orthopnea,PND and associated with dry cough from past 2 days ,he also complaining of chest pain from past 5  days ,pain on right side of chest ,increased with cough pricking  type of pain on deep inspiration ,non  radiating.

History of pain abdomine since 5days ,pain in right upper quadrant,dragging type of pain ,no radiation of pain. 

no history of nausea vomittings,diarrhoea .

he has hypertension since 2 year ,on medication and he has  stopped taking medication since  1month .

not a k/c/o DM,CAD,CVA,asthma, TB,epilepsy

he is an alcoholic from past 20 years,he consumes 90 ml of whiskey per day .

General examination :

pt is c/c/c ,well built,nourished

no pallor,icterus,cyanosis,clubbing,lymphadenopathy,oedema.

vitals : temp : 98.2'f

           bp : 110/70 mmhg

           pr : 110 bpm

          rr : 18 cpm

        grbs : 99 mg/dl

systemic examination:

CVS: s1 s2 heard

RS: 

Inspection: decreased expansion of right side of chest

Palpation: decreased movements noted in right side of chest in inframammary , scapular areas,infra axillary area

percussion: dullness noted in right side of chest from 5th  intercostal space 

Auscultation: ,decreased air entry in right of lung ,decreased sounds in RT IMA,IAA, ISA,SCAPULAR AREA

P/A:soft , mild tenderness noted in right upper quadrant

CNS: NAD

provisional diagnosis:Right sided pleural effusion with liver abscess, with k/c/o hypertension

 INVESTIGATION:

ecg:

x ray chest:

ultrasound chest:

ultrasound abdomine:

CECT 

https://youtu.be/qLckdxrW1T0

https://youtu.be/rgecUzjZARM

https://youtu.be/91ZheVpq1L0

plural fluid samples

light's criteria

plural fluid protein/serum protein = 4.6/6.2 =0.74

plural ldh/serum ldh= 671/130= 5.16

plural fluid ADA is 12 U/L

plural fluid  cytology

1. volume---2ml

2.appearance--- slightly cloudy

3. colour---- yellow

4. total count-- 85 cells/mm3

5. differential count

Neutrophils ---- 80%

lymphocytes---- 20%

ESR:

CBP:

CUE:

LDH:

RBS:

RFT

LFT

pulmonologist opinion was taken

general surgery opinion was taken:

Treatment:

DAY1:

1)inj OPTINEURON 1 AMPULE IN 100 ML NS/IV/OD

2)TAB PCM 650 MG /SOS

3)INJ PAN 40 MG IV OD

4)INJ METROGYL 750 MG IV TID

5)TAB TELMA 40 MG OD AT 8 AM 

DAY2:

complains of SOB on exertion

decreased pain at chest 

stools passed 

vitals : temp : 100.1'f

            bp : 130/ 90 mmhg 

           PR : 112 bpm 

           RR: 28 cpm 

           grbs : 108 mg /dl

input/output: 650/800 ml

1)inj OPTINEURON 1 AMPULE IN 100 ML NS/IV/OD

2)TAB PCM 650 MG /SOS

3)INJ PAN 40 MG IV OD

4)INJ METROGYL 750 MG IV TID

5)TAB TELMA 40 MG OD AT 8 

6)INJ TRAMADOL 50 GM IN 100 ML IV SOS

7)TAB ALBENDAZOLE 400 MG BD X 14 DAYS (D 

1/14)

8)TAB   Augmentin 625mg tid x 7 days