Morning ReportMorning ReportApril 6th , 2015

Suparman, male,54 yo, MWSuparman, male,54 yo, MW

Cc:◦ Abdominal enlargement since 18 days ago

Present Illness History◦ Abdominal enlargement realized since 18 days ago◦ Fever come and go since 18 days ago, high,

sometimes chilling but no excessive sweating◦ 15 days ago, patient had been hospitalized in

private hospital for 3 days, and then in Bayangkara hospital for 2days, got abdominal sonography and CT Scan with result susp. Hepatoma

◦ Nausea and vomite since 1 week ago, freq 2-3 x/day, about ¼ glass, no blood

◦ Pain in the upper right quadrant abdomen felt sometimes, but only mild-moderate pain, not influenced by position

◦Loss of appetite since 3 weeks ago◦Decrease of body weight is denied◦History of diarrhea (-)◦History of hepatitis (-)◦History of blood transfusion (-)◦History of often consuming beans (-)◦Defecation and micturition are

normal

Physical ExaminationPhysical ExaminationConsciousness level: cmc

BP : 120/80 mmHg

HR : 76x/minute

RR : 20x/minute

T: 36,70 C

Eye◦ Conjunctiva are anemic -/-◦ Sclera are icteric +/+

Neck◦ JVP 5-2 cmH20

Lung:◦ Inspection: simetric◦ Palpation: fremitus left=right◦ Percussion: sonor◦ Auscultation: bronchovesicular, Rales -/-,

wheezing -/-

Cor:◦ Inspection: ictus is not seen.◦ Palpation: ictus is palpated at 1 finger medial

LMCS ICS V◦ Percussion:

Left border: 1 finger medial LMCS ICS V Right border: linea sternalis dextra Upper border: RIC II

◦ Auscultation: pure rhythm, no murmur

Abdomen:◦ Inspection: enlargement (-)◦ Palpation: liver 2 finger UAC, 3 finger UPX

blunt edge, soft, unflat surface, fluctuation (+) tenderness (+)and spleen are not palpable

◦ Percussion: tymphani◦ Auscultation: bowel sound (+) normal

Extremities:◦ Physiologic Reflex +/+◦ Pathologic Reflex -/-◦ Oedema -/-◦ Palmar eritema (-)

LaboratoryLaboratory

Hb 10,4 mg/dl

Ht 32%

WBC 18.730/mm3

Platelet 498.000/mm3

RBG 149 mg/dl

Ur/cr 19/0,8

Na/K/Cl 129/4,5/99

Working DiagnoseWorking DiagnosePyogenic liver abcess

Differential Diagnoses :Amoebic liver abcessCentral necrotized hepatoma

TherapyTherapyRest/ soft diet liver diet IIIVFD aminofuchsin hepar :

triofuchsin 1:2 8 hours/kolfInj cefotaxime 2x1 gr (iv) skin

testsistenol 3x500 mgCurcuma 3x1

PlanPlanCheck complete blood count,

SGOT,SGPT,Alb,Glob,Bil I/II, hepatitis marker, AFP

Abdominal sonography