50 year old with abdominal pain

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CASE:

This is a case of 50 yr old male farmer came to Opd with chief c/o abdominal pain since december 4th 2022.

HOPI :

Patient was apparently asymptomatic 2 months back.Then he developed abdominal pain after consumption of food on 4th december 2022 in epigastric region and left iliac region.The pain is squeezing type,non radiating,increasing after consumption of food,lasts for about 20 to 30 minutes and relieves on its own,associated with abdominal bloating.

No h/o belching

No h/o regurgitation,

No h/o vomiting,

No h/o loss of apettite,

no h/o diarrhoea or constipation.

No h/o fever,

no h/o blood in stools,

no h/o SOB.

No h/o burning micturition

PAST HISTORY:

No similar complaints in the past.Not a known case of Htn,DM2,TB,Asthma,epilepsy,CVA,CAD.

PERSONAL HISTORY:

Mixed diet

Sleep and apettite normal

Bowel and bladder regular 

Addictions:- known smoker since 20 yrs 

                      smokes 8 to 10 cigarettes/                             day 

                      Occasional drinker 

                      Chews betel nut and khaini 3                         times/day 

No allergies 

FAMILY HISTORY:

Not significant

GENERAL EXAMINATION:

-  Patient was examined after taking his consent 

-  Patient is conscious , coherent , cooperative , well oriented to time , place and person 

-  He is moderately built and nourished 

-  No signs of pallor , icterus , cyanosis , clubbing , oedema , lymphadenopathy 

His vitals: 

Temperature : afebrile

BP : 120/80 mm HG 

Pulse rate : 78 / min 

Resp.rate : 16 cpm

Grbs:103 mg/dl

Systemic Examination:

GIT examination:-

Inspection

Oral cavity:-No dental caries,Staining of teeth seen

Abdomen:- 

Scaphoid shaped,

Umbilicus centrally placed and inverted,

No visible scars and sinuses,

No visible dilated veins,

No visible peristaltic movements or pulsations.

All quadrants move equally with respiration

Palpation:-

Done on supine position

No local rise of temparature 

No tenderness/rigidity /guarding

No hepatomegaly 

No sleenomegaly 

No other palpable mass felt 

Percussion:-

Tympanic note heard

Auscultation:-

Bowel sounds:- 8/ minute

Respiratory system Examination:-

Bilaterally symmetrical chest,

Chest movements with respiration are equal on both sides

Normal vesicular breath sounds heard

CVS examination:-

S1 S2 heart sounds heard

CNS examination:-

No focal neurological deficits

Investigations:-

USG abdomen:

Hemogram:-

Diagnosis:-

Solitary liver abscess(37mm×23mm heteroechoic solid lesion in segment 4B of liver)