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