a case presentation / study on cholelithiasis

This is a case study prepared on cholecystitis (gall stones).For academic purpose of pharma D , and also for study aspects.

1. Cholelithiasis CASE STUDY BASED ON DISEASE CHOLELITHIASIS PREPARED BY MARTIN SHAJI Pharm D NIRMALA COLLEGE OF PHARMACY(NICP) , KADAPA

2. Patient name – Mr. x OP no. – 4367 Admission date- 8/1/19 Age-58 Sex-M Department- GMW PATIENT DEMOGRAPHY

3. CHIEF COMPLAINTS; Pain in the right upper part of the abdomen and  between the  shoulder blades , some times back . In addition to pain, nausea, and vomiting, Abdominal irritations and indigestion , feeling over thirst. PAST MEDICAL HISTORY Elevated cholesterol level still 1 year. ALLERGY :(food/drug/other) No known allergies. PERSONAL HISTORY AND HABITS : Diet: Mixed Sleep: normal FAMILY HISTORY: Nothing significant.

4. GENERAL EXAMINATIONS 1. Physical examination: Vital signs: Temperature ( o F ): afebrile Pulse rate (/min): 80beats Respiratory Rate (/min): 25 cycles Blood Pressure (mm of Hg): 120/80mm of Hg Obesity noticed. 2. Systems Examination: CVS: S1, S2 + RS: Clear

5. PLANNING 1.   A bdominal ultrasound , Followed by o ther imaging techniques such as   ERCP  and  MRCP should done. 2. LIPID PROFILE TEST

6. LAB INVESTIGATIONS Lipid profile test; Total cholesterol: 230mg/dl [140-200mg/dl] Triglycerides : 200mg/dl [60-150mg/dl ] High density lipoprotein : 32mg/dl [40-75 mg/dl ] Low density lipoprotein: 170mg/dl [50-130 mg/dl ]

7. SOAP NOTES SUBJECTIVE EVALUATION A 58 years old male patient was admitted with experience  referred pain on right abdomen and  between the  shoulder blades . In addition to pain, nausea, and vomiting. OBJECTIVE EVALUATION : On Examination, the patient was conscious & coherent. ASSESSMENT: Based on subjective & objective evaluvation and also after abdominal ultrasound scan con f irmed it as CHOLELITHIASIS/ gall bladder stone. ( A positive  Murphy's sign  is a common finding on  physical examination  during a gallbladder attack.)

8. { cholelithiasis } CONFIRMATORY DIAGNOSIS

9. Sl.No . Drug Indication ROA Dose. Frequency Generic Name 1. ursodeoxycholic acid   Gallstone Solubilizing Agents oral 200mg BID 2. Colestipol Bile acid sequestrant oral 5mg BID 3. Omega 3 Omega-3 fatty acids oral 2gm BID 4. Ondansetron inj Antagonist oral 4mg sos

10. PHARMACIST INTERVENTIONS The prescribtion was rational. No DDI or ADRs were found.

11. To reduce your risk of developing gallstones, Maintain a normal body weight , Exercise regularly, Eat three well-balanced meals every day. Eat plenty of foods containing fiber and calcium, and avoid alcohol and foods high in saturated fat. If you're overweight, reduce your weight, but don't try to lose weight too fast. Your healthcare provider can help you come up with a plan for healthy weight loss. . PATIENT COUNSELING- Instructions for patient

12. 2. T.Colestipol  (trade names Colestid (’ Cholestabyl ) is a bile acid sequestrant used to lower blood cholesterol, specifically low-density lipoprotein (LDL ). PLANNING-Regarding medication. 3. Omega-3 fatty acids . Decrease triglycerides; may increase HDL levels T.Bile acid sequestrants   The liver then produces more  bile acids  to replace those that have been lost. body  uses  cholesterol to make  bile acids , this reduces the level of LDL cholesterol circulating in the blood . 1. T.Ursodiol is used to dissolve certain types of gallstones, to prevent gallstones from forming in obese patients who are losing weight rapidly, and to treat a certain type of  liver  disease (primary biliary cirrhosis). Ursodiol is a bile acid.

13. DISCUSSION Cholelithiasis is the presence of one or more calculi (gallstones) in the gallbladder. In developed countries, about 10% of adults and 20% of people > 65 yr have gallstones. Gallstones tend to be asymptomatic. The most common symptom is biliary colic; gallstones do not cause dyspepsia or fatty food intolerance. More serious complications include cholecystitis ; biliary tract obstruction (by stones in the bile ducts [ choledocholithiasis ]), sometimes with infection (cholangitis); and gallstone pancreatitis. Diagnosis is usually by ultrasonography. If cholelithiasis causes symptoms or complications, cholecystectomy is necessary.

14. NON-PHARMACOLOGICAL TREATMENT Surgery to remove the gallbladder (cholecystectomy).  Your doctor may recommend surgery to remove your gallbladder, since gallstones frequently recur. Once your gallbladder is removed, bile flows directly from your liver into your small intestine, rather than being stored in your gallbladder.