A Case Presentation on Cholelithiasis by Dr Saleem.pptx

A case presentation on Cholelithiasis

1. A CASE PRESENTATION ON CHOLELITHIASIS Dr. Muhammad Saleem PGR G Surgery Gulab Devi Hospital Lahore

2. Presenting complaint : A 44 years old female named Fehmida presented in ER with complaint of Abdominal pain and Vomiting from 1 day.

3. History of presenting complaint: Patient was alright 7 days back when she started having pain in Upper abdomen which was more in RUQ, sudden in onset, sharp, colicky in nature, radiating back, non shifting, relieved by Analgesics, not associated with fever, increase pain after eating. For 1 day pain intensity was increased which did not settled with analgesics Also Has history of 4 episodes of vomiting since 1 day, which contain food particles, no blood or mucus present, non projectile, brownish in color, No history of any trauma or weight loss

4. General and systemic review: General Review: No change in appetite,, sleep pattern or mood . No H/O weight loss SYSTEMIC REVIEW : GIT : Abdominal Pain and Vomiting present, No diarrhea ,constipation, dysphagia, dyspepsia, Respiratory system: No cough, stridor, hemoptysis, shortness of breath

5. Contd.. CNS. : no diplopia, fits or headache, tingling, numbness, visual loss Cardiovascular system: no orthopnea/ shortness of breath/ , no palpitations, chest pain or edema Genitourinary system: No dysuria, urinary frequency or urgency, polyuria, nocturia or hematuria

6. Detailed history: Past medical history:. Non diabetic, non hypertensive, no other known comorbidities Past surgical history:. Not significant Personal history: Married, 3 children, nonsmoker Family history: No history of DM,HTN,IHD,Tb,Asthma Medication/Feeding History:. No regular medication taken, normal sleep and appetite Allergies:. No known allergies Socioeconomic history: Lower socioeconomic status

7. General physical examination A middle aged female lying in bed, alert, well orientated in time and space and Vitally stable No pallor, cyanosis, jaundice, koilonychia, leukonychia, clubbing,, edema , distended veins

8. Abdominal Examination findings: Inspection : Abdomen was symetrical, no scar marks or striae Auscultation: Bowel Sounds audible Percussion: no visceromegaly Palpation: Abdomen was soft, non distended, mild tenderness in RUQ, Murphy’s +ve, no mass palpable

9. Systemic examination: Respiratory: Normal vesicular breathing, no added sounds CNS: GCS 15/15, No focal neurological deficits, normal sensory and motor function CVS: S1+S2 +0 Genitourinary: No significant findings were noted

10. Differential diagnoses: Biliary Colic/Cholecystitis Acute Pancreatitis Acute Appendicitis SAIO

11. Investigations: All baselines (CBC, LFTs, RFTs, serum electrolytes, viral markers) Serum amylase & lipase CXR( PA view) USG Abdomen & Pelvis Xray Abdomen Erect, Supine ECG

12. Ranson Criteria: At time of admission was Age: 44 Years WBC: 13400 AST: 29 Glycemia: 94 LDH: ….

13. Complete Blood Count

14. Xray Supine Erect

15. USG Abdomen

16. MANAGEMENT PLAN: . After clinical history, examination and investigations, Final diagnosis of CHOLELITHIASIS with CHOLECYSTITIS was made and Conservative management was started

17. Conservative Management: NPO TFO IV Fluids IV Antibiotics IV Analgesics IV PPI

18. Cont … After conservative management, Lap Cholecystectomy was planned Preoperatively; Anesthesia fitness, Blood grouping and crossmatching, consent, npo at 12am

19. Operatively;

20. Postoperatively; NPO for 6 hours IV Fluids IV Antibiotics IV PPI IV Analgesics Drain output monitoring Vitals monitoring Dressing monitoring Incentive Spirometry

21. Recovery The patient recovered without any complications Wound condition remained satisfactory Drain was removed on the 2nd postop day The patient was discharged on the 2nd postop day with advice for followup after 7 days Histopathology report was awaited