1601006197 SHORT CASE

1601006197 SHORT CASE

Case: A 55year old male toddy climber by occupation came with complaints of pain abdomen and fever.

Following is my analysis of this patient's problem:

The problems in order of priority I found are 

1) Severe pain abdomen since 14 days

2) Fever since 7days

Chief complaints: 

                            A 55 year old male patient,toddy climber by occupation, resident of miryalguda,came with complaints of 

1)pain abdomen since 14days

2) Fever since 7 days 

HISTORY OF PRESENTING ILLNESS:

         Patient was apparently asymptomatic 14 days back and later developed -

 

     -severe pain abdomen in the right upper 

    ~  Region--right upper quadrantof abdomen ,.         ~Onset.  -sudden 

      ~Gradually progressive

      ~Type -dragging type 

      ~non radiating pain.

      ~Aggravating on standing position 

      ~Relieved for  sometime upon taking medication.

 And pain abdomen not associated with nausea , vomiting ,loose stools 

   -And then later developed fever since 1 week 

   

   FEVER-high grade

     continuos type and associated with chills and rigor. 

      It is not associated with Cold,cough, shortness of breath,neckpain,giddiness,headache and sweating.It is relieved mildly upon taking medications

-No complaints of chestpain, palpitations and burning micturition.

Abdominal examination::

Umbilicus: Normal (inverted)

No visible pulsations 

No Visible peristalsis

All quadrants of abdomen moving equally on respiration.

1)SHAPE of the abdomen: scaphoid

2) There is  abdominal tenderness on Right upper quadrant           

    

3)Liver span normal 11 cm

Auscultation

 Bowel sounds heard

Liver and spleen not palpable

MY THOUGHTS IN THIS CASE

Based on right upper quadrant pain,14day fever   and investigations THE anatomy of location of the problem confines to Liver.

Based on history of the patient there is underlying liver pathology and bacterial infestation causing liver abcess may be seen and it is confirmed by 

Ultrasound