Gas Under Right Hemidiaphragm: A Rare Presentation of Unruptured Liver Abscess

A perforated liver abscess mimics hollow viscus perforations. It may be accompanied by pneumoperitoneum and peritonitis. A hollow viscus perforation appears to be the most common cause of gas under diaphragm. In about 10% of the cases, it can be due to rare abdominal and extra-abdominal causes. One of the causes could be intra-abdominal infection caused by gas-forming organisms. We are reporting a rare case of pneumoperitoneum resulting from an unruptured liver abscess in an old male with no comorbidity. An unruptured pyogenic right lobe liver abscess in a 70-year-old male was accompanied by X-ray flat plate abdomen features suggestive of free gas under the right hemidiaphragm. Culture of the pus drained from liver abscess grew Klebsiella sensitive to piperacillin and tazobactam, and antibiotic treatment was administered.

Study of Acid Base and Electrolyte Disturbances in Patients of Acute Myocardial Infarction

Introduction: Myocardial infarction is the main cause of deathin Western countries, with in hospital mortality of 6-13%. Acidbase and electrolyte status in AMI patients at the time ofadmission that can be help in risk stratification and it can helpfor further planning of management strategy for managementof patient with AMI.Aim of Study: To Study of Acid base and electrolytedisturbances in patients of acute myocardial infarction andrelation of Hypokalemia and hypomagnesemia with ventricularArrhythmias in AMI.Materials and Methods: This Observational study wasconducted in the department of Medicine at R.N.T. MedicalCollege and Govt. MB Hospital, Udaipur. Study subjects were50 patients of acute ST segment elevated Myocardial Infarctionpresenting within 24 hrs of onset of chest pain. We estimatedtheir acid base status, serum sodium, serum potassium, serummagnesium.Results: The definite correlation was found between metabolicacidosis and mortality (p=0.03). There was also increasedmortality in patients with hyponatremia, but p value was notstatistically significant (p=0.15). In our study definite correlationfound between hypokalemia and ventricular arrhythmias andalso between hypomagnesemia and ventricular arrhythmiasthere was increased tendency towards developing ventriculararrhythmias in patients with hypokalemia andhypomagnesemias. There was no correlation found betweenhypernatremia and mortality and between increased potassiumlevel and ventricular Arrhythmias in our study