67F PTB ACUTE CALCULOUS CHOLECYSTITIS

66 YEAR OLD FEMALE CAME WITH

-C/O ABDOMINAL DISTENTION SINCE TODAY MORNING(8/6/23).

-C/O BURNING TYPE OF PAIN IN UPPER ABDOMEN SINCE 2 DAYS.

HOPI:

PATIENT WAS APPARENTLY ASYMPTOMATIC 2 DAYS BACK AND THEN DEVELOPED BURNING TYPE OF PAIN IN UPPER ABDOMEN. NO AGGRAVATING AND RELIEVING FACTORS, PAIN NOT RADIATING TO ANY OTHER QUARDRANT.

NO H/O FEVER, CONSTIPATION, VOMITING, BURNING MICTURITION.

NO H/O TRAUMA.

H/O DECREASED APPETITE SINCE 20 DAYS(SINCE USAGE OF ATT).

PAST HISTORY:

H/O HYSTERECTOMY DONE IN 2001.

N/K/C/O DM, HTN, CVA, CAD, EPILEPSY.

H/O ASTHMA SINCE 35 YEARS.

H/O TB, DIAGNOSED LAST MONTH AND STARTED ATT.

PATIENT HAD C/O PAIN IN RUA 20 DAYS BACK AND GOT ADMITTED UNDER GS-VI AND USG WAS DONE SHOWING CHOLELITHIASIS.

HRCT CHEST- MULTIPLE CENTILOBULAR NODULES IN BOTH LUNGS.

ON EXAMINATION:

PALLOR(+)

NO SIGNS OF CLUBBING, CYANOSIS, ICTERUS, EDEMA TEMP-AFEBRILE, BP-120/80 MMHG, PR-86BPM, RR-32CPM,SPO2-99% @2L 02,GRBS-136MG%

PER ABDOMEN INSPECTION: -ABDOMEN IS DISTENDED

-UMBLICUS IS CENTRAL AND INVERTED.

-NO SINUS, HYSTERECTOMY SCAR (+)

-NO ENGORGED VEINS.

-ALL QUADRANTS OF ABDOMEN MOVES EQUALLY WITH RESPIRATION

-NO VISIBLE GASTRIC PARALYSIS.

PALPATION:-SOFT, NON-TENDER, NO GUARDING, NO RIGIDITY AUSCULTATION-BOWEL SOUNDS -PRESENT

RESPIRATORY SYSTEM:

TRACHEA CENTRAL, BAE+, NVBS HEARD RHONCHI PRESENT

Investigation

2D ECHO(8/6/23):

TRIVIAL TR(+/AR(+), NO MR

NO RWMA, NO AS/MS, SCLEROTIC AV.

GOOD LV SYSTOLIC FUNCTIONS.

DIASTOLIC DYSFUNCTION(+), NO PAH/PE.

USG-ABDOMEN(8/6/23):

-E/O MULTIPLE CALCULI NOTED IN GALL BLADDER IN FUNDUS AND NECK, LARGEST MEASURING 8MM.

-NO PERICHOLECYSTIC COLLECTION.

-NO GB WALL EDEMA.

USG-CHEST(9/6/23):

-ACUTE CALCULOUS CHOLECYSTITIS WITH COLLECTION AND SEALED OFF PERFORATION.

-NO SONOLOGICAL ABNORMALITIES IN THE CHEST.

Treatment Given(Enter only Generic Name)

02 INHALATION WITH 1-LITRE 02 WITH NASAL PRONGS TO MAINTAIN SPO2>94% SOFT DIET

INJ. MEROPENUM 1GM SLOW IV/TID INJ.METROGYL 500MG IV/BD

INJ.AMIKACIN 500MG IV/BD

TAB. ZOFER 4MG PO/SOS TAB. ACELO PO/BD TAB. CHYMEROL FORTE PO/TID ATT(4 TABS) PO/OD TAB. BENEDON 40MG PO/OD INJ. PAN 40MG IV/BD INJ.BUSCOPAN IM/STAT IVF NS 500ML ,75ML/HR ,IV/BD

INJ. PIPTAZ 4.5GM IV/TID

NEB. WITH IPRAVENT X 8TH HOURLY NEB. WITH BUDECORT X 12TH HOURLY.

PROTEIN POWDER 2 TS WITH 1GLASS OF MILK (TID)

CHEST PHYSIOTHERAPY INTENSIVE SPIROMETRY 2ND + JURLY

Advice at Discharge

TAB. TAXIM-O 200MG PO BD (X-1-1) TAB. PANTOP 40MG PO OD (BBF) X5 DAYS TAB. BUSCOPAN 10 MG PO SOS TAB. MVT PO OD X 5 DAYS CST

CONTINUE ATT UNDER NTEP 4 TABS PER DAY

INS. PIP TAL 4.5GM IV/TID

NEB. WITH IPRAVENT X 8TH HOURLY NEB. WITH BUDECORT X 12TH HOURLY.

PROTEIN POWDER 2 TS WITH 1GLASS OF MILK (TID)

CHEST PHYSIOTHERAPY INTENSIVE SPIROMETRY 2ND + JURLY


Advice at Discharge

TAB. TAXIM-O 200MG PO BD (X-1-1) TAB. PANTOP 40MG PO OD (BBF) X5 DAYS TAB. BUSCOPAN 10 MG PO SOS TAB. MVT PO OD X 5 DAYS CST

CONTINUE ATT UNDER NTEP 4 TABS PER DAY

TAB. BENADON 40 MG PO/OD

INHALER FORGLYN MDI WITH SPACER (BEFORE BREAKFAST 2 WEEKS)

HIGH PROTEIN DIET 2 EGG WHITES PER DAY

OUTCOME COMPLETELY RECOVERED 


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