gall bladder
Post on 08-Jan-2017
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Where there's awill ,there's a way
بسم الةل الرمحن الرحمي
Republic of Yemen
Faculty of Medicine &
Health Science
pharmacy department
Practice clinical pharmacy
In General Thamar hospital
ادلكتورة
صفية عبداللطيف الرزايم
Where there's awill ,there's a way
Personal history
file no, 113)) Patient Name : X Sex :female-
Age: 45 years work as housewife-
Admission date 17-3-2013 -
discharge date 27-3-2013-
The main compliance Patient was admitted to hospital complaing of right upper abdominal pain and vomiting.
Medical & past history
The patient has no history of HTN or DM or
Pt give history of taking large amount of NSAID for remove pain as she did not know she had gall bladder stone
Also there is no past history of hospitalization .Both parents have no any chronic diseases
Information paper of in patient
Where there's awill ,there's a way
Primary diagnosis Acute cholycystitis
Differential diagnosis Perforiated peptic ulcer.
Renal colic.
Intestinal obestraction.
Rupture aortic anyorsm.
Acute hepatitis.
Acute cholycystitis.
Pylonepheritis. acute
The physical examination She is look ill and paller
BP:90 \60 mmhg
Pulse: 64 beat per minute
Respiratory rate: 22
Abdominal examination ,upper abdominal tenderness
Ultrasound examination .show gall bladder stone
Where there's awill ,there's a way
And inflmmation of wall gall bladder
Investigation
Wbc=10000 Hb=11
R.B.S =70mg\dl
Protective tests HIV , HCV , HBsAg ….. Negative
Final diagnosis
By the clinical examination and investigation this case diagnosed as acute calcular cholycystitis
Treatment
the operation was done after half hour post admitation Medication which given to the patint at the first five day of admitition area.
Where there's awill ,there's a way
At the five day the doctor add the following drugs beside the other.
Taken or Not
Therapeutic Use
Dose Drug Trade Name
Yes Supplment 1 3
Dextrose 5% + Normal saline
Infusion0,9%
DNS
Yes Antibiotic Anaerobic))
1 3 Metronidazole 500mg infusion
Flagyl
Yes at First 3 day
1 3 Vit.C
In patient drugs
Where there's awill ,there's a way
Taken by Patient
Use Use Dose Drug Trade name
yes Antibiotic
cephalosporine 1 2 Ceftriaxone Torcef 1g
yes Analgisic sos Tramadol 100\1ml
Tamadol
Out patient drug _Augmentine (AMOXACILLINE &CLAVERUONIC ACID)
1g tab 2time per dayfor 5 days
Tamadol (Tramadol) SOS
Omesac (omeprazole) 40mg once time at morning beforebreakfasting.
Where there's awill ,there's a way
Acute cholycystitis
Is inflammation of gall blader it can be calssifed into two type:
_Calcular cholycystitis it is inflammation of gall bladder caused by stone
_Acalcular cholycystitis it is inflammation of gall bladder by causes other than stone like typhoid
Symptoms & Signs
Symptoms included right upper abdominal pain,nausea,vomiting,
Signs included right upper abdominal tenderness,abdominal distenthon
Diagnosis
Can be diagnosed clinicallyl and by ultrasound .
Treatment
By operation by cholycystoectomy (remove of gall bladder)
Information about case of patient
Where there's awill ,there's a way
When we study this case treatment there is many note to make decision
-Why Use of Dextrose for10 days and sit in hospital long time?
Because the patient was vary triad and has nausea also has not suitable psychology case and the come to hospital in sever case .
--Why doctor start to give Torcef at five days post operation?
Because the case was no improvement strat to get fever.
Why in out patient omperzole?
To avoid stress gastritis after surgical ,
The End
Notes about the treatment
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