Liver Abscess

A 25 year old male presented to OPD(virtual consultation) after having been denied for admission and intervention for his liver abscess as he is covid positive Chief Complaints His main complaints are pain in right upper quadrant and he use to have fever few days back but not now History He is non alcoholic and non smoker He has had treatment before coming to me, like ceftriaxone, metronidazole, Lariago etc Investigations TLC are 25600, S.Cr 1.62 Xray reveals elevation of right dome of diaphragm due to liver abscess Management What would be the best line of management in this case? Being pandemic, and non availability of beds in hospital, what could be done, best at home for this case treatment?

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A case of COVID-19 disease with liver abscess ( Pyogenic or Amoebic ) with septicaemia and secondary uraemia to septicaemia Plan of treatment is clear cut - because antibiotics to be used which are not nephrotoxic and which can take care of septicaemia as well as secondary bacterial infection in atypical viral pneumonia . In my opinion treatment could be 1.In Piperacillin 4gm + Tazobactum 500 mg × 8 hourly 2.Inj Metrogyl infusion × 8 hourly 3.IV fluids on lower side 1 litre in 24 hours 4.Tab Ivermectin 12 mg O.D for 3 days 5.Antipyretic S.O.S 6.A serial Ultrasonography after a week 7.If scan at 14 days shows no sign of regression of abscess- CT guided drainage of abscess is indicated after getting PTI test done

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It's a very interesting case, Covid 19 positive with amoebic liver abscess Let's consider following points for this patient 1) WBC counts are very high 25,600/cmm, which indicates that this patient is in severe sepsis 2) serum creatinine 1.62 mg/dl , blood urea 68 mg/dl. Therefore calculated blood urea nitrogen is 31.7. BUN: S. CREATININE ratio 31.7: 1.62 It is approximately 20:1 BUN serum creatinine ratio of more than 10:1 indicate prerenal type of renal failure. In this case it is prerenal type of renal failure secondary to severe sepsis, which is completely reversible after treatment of sepsis. 3) There is solitary large liver abscess, which is characteristic of amoebic liver abscess. WBC counts are significantly raised which indicates secondary bacterial infection. 4) This patient is also Covid positive which need to be taken in to account. Discussion This patient is having large amoebic liver abscess, there is a risk of rupture of abscess which can be life threatening. Therefore this patient needs to be treated very aggressively. Adv 1) Glargine insulin 6 units once a day (nondiabetic patient), usually it do not cause hypoglycemia. However sugars need to be monitored. I am myself taking Glargine insulin for last one year with HbA1c of 5.1. Glargine Insulin helps in controlling infection very quickly. 2) Double dose metronidazole - 400 mg, two tablets three times a day for 14 days - this is standard treatment for amoebic liver abscess. 3) Cefixime 200 mg one tablet twice daily for 10 days, this is for superadded infection 4) For treatment of Covid 19, Tablet Azithromycin 500 mg once daily for 7 days, C. Doxy 100 mg twice a day for 7 days. Ivermectin 12 mg twice a day for 5 days. Montelukast Levocetrizine combination once daily for 10 days. Ecosprin 75 mg once daily for 30 days. Hopefully with above treatment there will be quick recovery of the patient. Please do update!

Sir, for metronidazole can we go IV like 6 hourly or 8 hourly?
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Already well explained by All seniors Doctors, IT'S a suggestive Case of Liver Abscess with NOVEL COVID-19 INFECTION, SERVE SEPSIS, PNEUMONITIS, MILD PERITONEAL ASCITES, Anemia, Dysfunction of KFT, FOR COVID -19 TREAT AS PER ICMR PROTOCOL AND SYMPTOMATIOC, Urgent Do FNAC For HPE, HRCT CHEST, CRP, LDH, D-DIMMER, PCT, IL-6 , TIBC, UIBC, URINE R/M, LFT,HBsAg, PUS drained out through USG Guided, Then Start INJ. MEDICINE

Only option for this pt to give relief is aspiration of LIVER ABSCESS Unless pus is evacuated fever and pain will not subside and medication could be helpful whatsover. Post aspiration you can offer inj dehydroememetine Pts KFTS are deranged bcz of covid and consistent fever hence need to check electrolytes and to correct and compensate that so KFTS will improve

Thanx dr Kute Ankush
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? LIVER ABSCESS .. NEED'S .. GASTROENTEROLOGIST OPINION .. USG GUIDED ASPIRATION .. PUS C AND S..EXAMINATION.. ACCORDINGLY FURTHER MANAGEMENT..

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Ad FNAC for HPE Aspiration of pus C/S of pus After results of reports start treatment Till then Inj Ceftrioxone 1. G M I v bd Inj Metrogyl iv drip bd

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FNAC for HPE. Pus aspiration for c/ S Under present circumstances of pandemic you must follow protocols of COVID pandemic set by ICMR till reports prove otherwise. Inj ceftam 1 gm iv bd slowly Inj metrgyl 100 ml TDS Inj buscopan SOS for pain Multivitamin in drip Symptomatic treatment till reports complied.

Thanks Dr Pushkar Bhomia
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Congratulations! Your case has been selected as Case of the day and you have been awarded 5 points for sharing the case. Keep posting your interesting cases, Happy Curofying!

Thank you doctor
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It seems to be case of pyogenic liver abscess . Usually it requires drainage percutaneous with a pig tail catheter as this pt is having high leukocyte count with mild kidney function dranged. But pt is is all time vulnarable to develpe bacteraemia or septaemia giving rise to high mortality . But as the pt is Covid positive and denied admission in hospital so conservative treatment with antibiotic with higher range like Inj piperacillin 4 gm and tazobactum 500 mg 12 hrly or 8 hrly Inj metrogyl 100 mg iv 8 hrly Nutrition to mai tain keeping in mind the renal function derangement Other supportive treatment like antipyretic , vitamins Repeated USG/ CT to asses the condition to see the signs of resolution and at the same time the asses the clinical status of the pt if there signs of resolution is there to continue treatment if no resolution and condition detoriates then urgent under CT/ USG guided percutaneous drainage with a pigtail catheter.

Thanks Dr Ajit Pal Singh
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25/M.. positive covid19 case with liver abscess with Azotemia Send this blood C/S..according to report start Antimicrobial treatment.. Cause of this acute renal failure would require to find out..send urinalysis R/M.. Covid19 progression need to understand thru various reports under which category treatment ptn on.. Keeping in mind kidney dysfunction antibiotics Dosage should be managed..

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