Case presentation on Gall Stones

1. CASE PRESENTATION
ON CALCULOUS
CHOLECYSTITIS
Vignesh.G
Pharm-D 5TH Year

2. What is calculous
cholecystitis??
INTRODUCTION
It is the formation of stone in the gallbladder, a small organ located under the liver.
The gallbladder aids in the digestive process by storing bile and secreting it into the
small intestine when food enters. Bile is a fluid produced by the liver and is made
up of several substances, including cholesterol, bilirubin, and bile salts.
Gallstones are pieces of solid material that form in the gallbladder. These stones
develop because cholesterol and pigments in bile sometimes form hard particles.
The two main types of gallstones are:
Cholesterol stones: Usually yellow-green in color, approximately 80% of
gallstones are cholesterol stones.
Pigment stones: These stones are smaller and darker and are made up of
bilirubin.

4. Demographic details
 Name :Mr.ABC
 Age :53yrs
 Sex: Female
 Weight :62kg
 IP NO: 15121413471
 UHID NO:1000156256
 Unit:1
 DOA:15/12/14
 D0D:16/12/14

5. SUBJECTIVE EVIDENCE:
 C/o Abdominal pain since 2weeks.
 C/o Fever since 4days
No history of jaundice or fever
Not K/C/O DM,HTN,IHD,Asthma

6. OBJECTIVE EVIDENCE
VITALS D1 D2 D3 D4
TEMP(F) 101 98.6 99 98.4
PULSE(bpm
)
86 80 75 68
RR(cpm) 20 20 20 22
BP(mmHg) 130/90 120/80 130/80 110/80

7. LABORATORY DATA:
TEST TEST VALUE NORMAL VALUE
Serum Amylase 97U/L 23-85U/L
Serum Lipase 213U/L <160U/L
WBC 14.2*109 cells /L 4.3-10.8
SGOT 78U/L 13-40U/L
SGPT 62U/L 13-40U/L
GGT 229U/L 15-73U/L
ALP 390U/L 53-128U/L
TOTAL
BILIRUBIN
10.4mg/dL 0.2-1.3mg/dL

8. Other diagonostic test:
Angiography – Kidney and Bladder and
abdomen was caried out showed normal results
CT Scan of gall bladder showed stones which is
a supportive screening.

9. Assesment
 From subjective and objective data its
confirmed that patient is having Gall Stones.
 Therapy plan- Laparoscopic Cholecystectomy

10.  Day 1:(1/9/14)
Patient was admitted with severe abdominal
pain.
Lab investigation carried out to yield abnormal
liver tests.
CT scan- Stones in bladder.
 DAY 2:(2/9/14)
Laparoscopic cholecystectomy surgery was done
and patient under supportive care.

11. Day 3:(3/9/14):
Mobilization wound healing, diabetic
diet, feeling relieved of abdominal pain.
Blood in urine due to surgery
DAY 4:(4/9/14):
No fresh complaints, Vitals stable, relieved
Day 5: (5/9/14):
Better, stable, advised for discharge.

12. Prescribed Medications
Brand Name Dose FreQ ROA Days
Inj.Magnex forte 1.5g 1-0-1 iv ✓ ✓✓✓✓
T.PAN 40mg 1-0-0 oral ✓ ✓✓✓✓
Inj.Tramadol 50mg TID iv ✓ ✓✓✓✓
Inj.Emeset 4mg BID iv ✓ ✓✓✓✓
Inj.PCT 1g BID iv ✓ ✓
Inj.Diclofenac 1amp OD iv ✓ ✓✓✓✓
Diclofenac
suppository
100mg 0-1-0 P/R ✓✓✓✓
T.Anxit 0.25mg 1Hrly P/O ✓✓✓✓
T.Telmisartan 80mg OD P/O ✓✓✓✓

13. Discharge Medications
Medications Dose FREQ ROA Duration
T.Lumina 60000 U 1/weelk Oral 6 weeks
Pantoprazole 40mg 1-0-0 Oral 7 Days
T.Dolo 650mg 1-1-1 Oral 3 Days

14. Patient counselling
 Have Timely Medications
 To have a Balanced Diet
 Drink lots of water 3ltrs/day and stay hydrated
 Have lots of green leafy and eggs. Reduce non
vegetarian and fatty oily food, have soft food.
 Drink warm water
 Have a good sleep.
 Regular exercise to stay fit.

15. After a gallbladder is
removed!!
 You do not need a gallbladder to digest food. Bile still flows
from the liver to the gut once the gallbladder is removed.
However, there is no longer any storage area for bile between
meals. The flow of bile is therefore constant, without the
surges of bile that occur from a gallbladder when you eat a
meal.
 You can usually eat a normal diet without any problems after
your gallbladder is removed. However, up to half of people
who have had their gallbladder removed have some mild
tummy (abdominal) pain or bloating from time to time. This
may be more noticeable after eating a fatty meal. Some
people notice an increase in the frequency of passing stools
(motions, or faeces) after their gallbladder is removed. This is
like mild diarrhoea. It can be treated by antidiarrhoeal
medication if it becomes troublesome.