A 40 yrs old male patient
A 40 yrs old male patient ,auto driver by occupation came to hospital on 4/9/2021 with complaints of
-pain in left lateral side of chest since 5days
-SOB (grade-2) since 3days
Patient is chronic alcoholic since 10yrs (90-180ml /day)
In 2019- he had diffuse pain abdomen for 3months (4-5 times) , took medications from rmp then went to Osmania hospital, CT abd done & operated for distal CBD stricture on 28/8/19 (ERCP + stenting)
(Hospitalised for 1 month)
He is asymptomatic for 3months.
In 2020 - pt had SOB , insidious in onset , progressive to G-4 Diagnosed as massive pleural effusion for 1week & rt ICD was placed (11 lts of fluid removed)
Reports:protein-2.6 ,alb-0.6,sugar-116,ADA-16, amylase- 50639
On 31/7/2020- CECT abd done & grade4 ? right RCC (rt midpole Bosnaik 4cyst) chronic calcified pancreatitis+pneumobilia
15 days back ,he took alcohol then he had vomitings for 2days(2episodes/day)&pain in epigastric &left hypochondriac region for 2days
He is k/c/o HTN since 2yrs (on tab. Nicardia 20mg bd)
Personal history :
Mixed diet
Appetite decreased
B & B -regular
No allergies
Addictions- alcohol since 10years(90-180ml/day)
Smoking since 9years but stopped 4yrs back
General examination:
Pallor ,icterus,clubbing,cyanosis ,Edema,lymphadenopathy absent
Vitals -temp afebrile
PR-120 bpm
RR-28cpm
BP- 110/70 mm Hg
Spo2- 85% on RA
95 % on 16 lts of o2
Systemic examination:
CVS -s1 s2 heard
RS - trachea central
Dysnea + grade2
Wheeze +
Breath sounds decreased on left IAA & ISA
Crepts + in left IAA & ISA
Abd- scar +
Tenderness in left hypochondrial region
CNS - NTND
GCS- 15/15
Investigations :
Usg - 7.4x5cm hypoechoic lesion notes with internal echos& separation in segment -2&3(left lobe of liver with small communication with another collection 6x 4.5 cm in pleural cavity)
-? Fistulous communication
Final diagnosis-
acute on chronic pancreatitis (pseudocyst) with liver abscess with connection to left pleural space
Advice at discharge-
Dicharged on 5/9/2021 ,11 am on patient attender request ,so sent on LAMA
Follow up-
Aftr discharge , they went to Osmania hospital there he was hospitalised for 10days & left ICD was placed (1/2 lit fluid removed) ,medications given & discharged
Advised to come aftr 10days for followup
