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ABDOMINAL PAIN
SINCE ABOUT 1 WEEK BEFORE ADMISSION
By:
Bima Indra
Ainindia Rahma
Advisor:
Prof. dr. Eddy Mart Salim, SpPD, K-AI, FINASIM
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CASE
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CASE ILLUSTRATION
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IDENTIFICATION
Name : Mr. IW
Age : 41 yo
Address : Palembang
Religion : Islam
Status : Married
Occupation : Parking attendant
Admission : February 13th 2019
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ANAMNESIS
Chief Complaint
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PRESENT HISTORY OF DISEASE
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PRESENT HISTORY OF DISEASE
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PREVIOUSLY HISTORY OF
DISEASE
No history of liver disease
No history of hypertension
No history of DM
No history of heart disease, kidney disease and lung
disease
No history of allergy
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FAMILY HISTORY OF DISEASE
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HISTORY OF SOCIAL ECONOMY,
JOBS, AND HABITS
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PHYSICAL EXAMINATION
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PHYSICAL EXAMINATION
Head
Shape : Normocephali
Expression : Normal
Hair : Black, half white
Alopesia : (-)
Deformity : (-)
Tenderness : (-)
Puffy Face : (-)
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PHYSICAL EXAMINATION
Eye
Konjungitva Palpebra : pale
Vision : normal
Ear
Pain : (-)
Secret : (-)
Hearing disorders : (-)
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PHYSICAL EXAMINATION
Mouth
Hygiene : Good
Lips : Cheilitis (-), sianosis (-)
Tongue : dirty (-), atrophy papil (-)
Neck
Inspection : Trachea deviation (-)
Palpation : Enlargement of the thyroid gland/struma (-)
JVP : (5-2)cmH2O
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PHYSICAL EXAMINATION
Chest
Inspection : Normal chest form, no spacing
of the ribs, chest wall retraction (-), Spider nevi (-),
venektasi (-)
Palpation : tenderness (-)
Percussion : pain (-)
Auscultation : crepitation (-)
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PHYSICAL EXAMINATION
Lung
Inspection :
Static : dextra same with sinistra , Retraction(-)
Dynamic : dextra same with sinistra , Retraction(-)
Palpation : Tenderness (-), spacing of ribs (-), Tactile fremitus was
symmetrical on both lungs.
Percussion : pain (-), sonor in both areas of the lung
Auscultation : Vesicular (+) normal, rhonchi (-/-) on basal of the
lung, wheezing (-/-)
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PHYSICAL EXAMINATION
Heart
Inspection : Ictus cordis is not visible
Palpation : Ictus cordis is not palpable
Percussion : Upper right heart border is on right linea sternalis of
ICS IV and left heart border is on linea midclavicularis of ICS V
Auscultation : HR 83 x/m, regular heart sound I-II, no murmur and
gallop
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PHYSICAL EXAMINATION
Abdomen
Inspection : Convex, no venectation and scar
Palpation : Abdomen was relaxed, there was tenderness on upper
right quadrant, Ludwig sign (+), liver was palpable 3 cm below costal
margin and 3 cm below xiphoid process with soft consistency,
slippery surface, spleen and kidney ballotement are not palpable
Percussion : Thymphani, there was shifting dullness
Auscultaion : There was normal abdominal sound 5x/minutes
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PHYSICAL EXAMINATION
Extremity
Superior : no pale, warm, no peripheral edema, no
palmar erythema, and no clubbing finger
Inferior : no pale, warm. There was no peripheral
edema, no palmar erythema, and no clubbing finger
ROM : Active and passive range of motion of both
superior and inferior extremities is wide
Strength : The strength of right and left extremities
both superior and inferior is 5
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LABORATORY RESULT
Temporary Diagnosis
Liver abscess
Differential Diagnosis
Cholecystitis
Gastroentritis
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MANAGEMENT
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PROGNOSIS
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LITERATURE REVIEW
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LIVER ABSCESS
An encapsulated collection of suppurative material within the
liver parenchyma.
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AMOEBIC LIVER ABSCESS (ALA)
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AMOEBIC LIVER ABSCESS (ALA)
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AMOEBIC LIVER ABSCESS (ALA)
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AMOEBIC LIVER ABSCESS (ALA)
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AMOEBIC LIVER ABSCESS (ALA)
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PYOGENIC LIVER ABSCESS (PLA)
Rare disease
Primarily affects older individuals, with peak incidence between
50 to 60 years of age
Risk factors include diabetes mellitus, underlying hepatobiliary
or pancreatic disease, and gastrointestinal malignancy
Most PLA cases are polymicrobial, with commonly identified
pathogens including mixed enteric facultative and anaerobic
species.
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PYOGENIC LIVER ABSCESS (PLA)
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PYOGENIC LIVER ABSCESS (PLA)
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PYOGENIC LIVER ABSCESS (PLA)
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PYOGENIC LIVER ABSCESS (PLA)
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PYOGENIC LIVER ABSCESS (PLA)
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PYOGENIC LIVER ABSCESS (PLA)
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PYOGENIC LIVER ABSCESS (PLA)
Case series from the past decade report mortality rates of 2%-
14%.
Risk factors for mortality include advanced age, malignancy,
shock, jaundice, multiple abscesses, hemoglobin <10 g/dL, and
elevated blood urea nitrogen
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THANK YOU
Any question?
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