A 40 yr M with pain in right hypochondrium since 2 days associated with fever

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Here is a case i have seen:
Case history:
40 year old man -  carpenter by occupation 
Presented to our hospital with complaints of --------Fever high grade since 3-4 days , continuous, associated with chills and rigors 
-- pain abdomen - @ Right upper quadrant since 2 days ,radiating to back , gradually progressive 
Severe in intensity 
Assosciated with 2 episodes of vomitings- non bilious,non projectile , containing food particles and water 

He also complaints of burning micturition since 2 to 3 days

No h/o loose stools ,hematemesis ,no obstipation ,no constipation ,no pedal edema ,no abdominal distension .
Not a k/c/o DM,HTN,Asthma, Lymphadenopathy,CAD.

He is a chronic alcoholic since 18-20years - drinks daily 180 ml-500 ml  of whiskey daily.
Last alcohol binge was 5 days back .
Chronic smoker since -15 -20 years - smokes 1 beedi pack /day .
Past history:
History of hospitalisation 4 years back with similar complaints - and dark colored stools.He  was said to have liver infection back then.

On examination - 
Pt is conscious,coherent,cooperative
         Oriented to time,place and person.
    He is  thin built .
Icterus + 
Clubbing + 
Tremors + 
No signs of Pallor,cyanosis, lymphadenopathy,koilonychia,edema.
Febrile - continuous fever spikes since yesterday.
Vitals
Bp- supine - 130/100 mmHg
      Standing -100/80 mmHg 
PR- 112/min 
Spo2-99%
Temp-102 F
Grbs-108mg/dl
Systemic examination:

CNS-Normal.
CVS-s1s2 heard, no murmurs.
RESP SYSTEM- BAE +
Per abdomen - 
Umbilicus -normal central in position.
Tenderness at the right hypochondriac region .
Liver span - 17 cms.
No splenomagaly
INVESTIGATIONS


showed decrease in platelet count.
Usg abdomen- 
Provisional diagnosis : 
Viral PYREXIA with thrombocytopenia- resolving
Hepatocellular jaundice.
? Acute Hepatitis
Thrombophlebitis +

Treatment:
Day 1
Inj.Monocef 1gm/IV/bd
Inj. Metrogyl 500mg /IV /TID
Inj. Pan 40mg/ IV /od 
Inj. Zofer 4mg /IV /tid
Sup.Hepamerz 15ml/po/od
IV fluids- NS and RL
Tab MVT /po /od
Inj. Tramadol 1 amp in 100 ml NS IV
Syp.Lactulose 15 ml BD- to pass 3 to 4 stools/day
Tab. Udiliv 300mg /PO /BD
Sup. Hepamerz 15ml / PO H/S.
Tab.Ultracet /po/qid
Tepid sponging- for fever

Day 2
Inj.Monocef 1gm/IV/bd
Inj. Metrogyl 500mg /IV /TID
Inj. Pan 40mg/ IV /od 
Inj. Zofer 4mg /IV /tid
Sup.Hepamerz 15ml/po/od
IV fluids- NS and RL
Tab MVT /po /od
Inj. Tramadol 1 amp in 100 ml NS IV
Syp.Lactulose 15 ml BD- to pass 3 to 4 stools/day
Tab. Udiliv 300mg /PO /BD
Sup. Hepamerz 15ml / PO /od
Tab.Ultracet/po/qid
Day 3

Inj.Monocef 1gm/IV/bd
Inj. Metrogyl 500mg /IV /TID
Inj. Pan 40mg/ IV /od 
Inj. Zofer 4mg /IV /tid
Sup.Hepamerz 15ml/po/od
IV fluids- NS and RL
Tab MVT /po /od
Inj. Tramadol 1 amp in 100 ml NS IV
Syp.Lactulose 15 ml BD- to pass 3 to 4 stools/day
Tab. Udiliv 300mg /PO /BD
Sup. Hepamerz 15ml / PO H/S
Tab.Lasix 40 mg /po/bd
Tab.Ultracet/po/qid
Tab.Ondansetron 4mg/po/sos
Day 4 
Inj.Monocef 1gm/IV/bd
Inj. Metrogyl 500mg /IV /TID
Inj. Pan 40mg/ IV /od 
Inj. Zofer 4mg /IV /tid
Sup.Hepamerz 15ml/po/od
IV fluids- NS and RL
Tab MVT /po /od
Inj. Tramadol 1 amp in 100 ml NS IV
Syp.Lactulose 15 ml BD- to pass 3 to 4 stools/day
Tab. Udiliv 300mg /PO /BD
Sup. Hepamerz 15ml / PO H/S.
Tab.Thiamine 100mg/po/od
Tab.Lasix 40 mg /po/bd
Tab.Ultracet/po/qid
Tab.Ondansetron 4mg/po/sos

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