DC is a 46-year-old female who presents with a 24-hour history of RUQ pain
DC is a 46-year-old female who presents with a 24-hour history of RUQ pain. She states the pain started about 1 hour after a large dinner she had with her family. She has had nausea and on instance of vomiting before presentation.
PMH: Vitals:
HTN Temp: 98.8oF
Type II DM Wt: 202 lbs
Gout Ht: 5’8â€
DVT – Caused by oral BCPs BP: 136/82
HR: 82 bpm
Current Medications: Notable Labs:
Lisinopril 10 mg daily WBC: 13,000/mm3
HCTZ 25 mg daily Total bilirubin: 0.8 mg/dL
Allopurinol 100 mg daily Direct bilirubin: 0.6 mg/dL
Multivitamin daily Alk Phos: 100 U/L
AST: 45 U/L
ALT: 30 U/L
Allergies:
Latex
Codeine
Amoxicillin
PE:
Eyes: EOMI
HENT: Normal
GI:bNondistended, minimal tenderness
Skin:bWarm and dry
Neuro: Alert and Oriented
Psych:Appropriate mood
Pharmacotherapy for Gastrointestinal and Hepatobiliary Disorders
Accurate patient diagnosis is vital in ensuring that individuals receive the most appropriate and effective medical care tailored to their specific conditions. In the case of DC, a 46-year-old female presenting with right upper quadrant (RUQ) pain, a meticulous diagnostic approach is paramount. This paper delves into the comprehensive evaluation of DC’s medical history, physical examination findings, vital signs, current medications, and notable laboratory results to arrive at a precise diagnosis and initiate appropriate management.
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Diagnosis and Rationale
The patient’s presentation suggests acute cholecystitis, an inflammatory condition of the gallbladder. The onset of pain after a large meal, particularly the RUQ pain, is consistent with gallbladder pathology, as gallbladder contraction triggered by dietary fat can exacerbate symptoms in patients with cholecystitis (Tanaja & Meer, 2019). Nausea and vomiting are also frequently associated with gallbladder inflammation due to the release of inflammatory mediators. These symptoms, along with a history of hypertension (HTN), type II diabetes mellitus (DM), and gout, indicate potential risk factors for gallstone formation (Zhang et al., 2022). The presence of minimal tenderness on abdominal examination supports this diagnosis. Additionally, a history of deep vein thrombosis (DVT) related to oral contraceptive pills (BCPs) might indicate hormonal influences on gallstone development.
Drug Therapy Plan
In light of the acute cholecystitis diagnosis, the recommended drug therapy plan consists of pain management, antiemetics, antibiotics, and cholecystectomy consultation. Analgesics, specifically nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen, should be prescribed to alleviate pain and reduce inflammation. However, caution is necessary due to the patient’s history of HTN. Thus, short-term NSAID use and vigilant blood pressure monitoring are essential (Ghlichloo & Gerriets, 2023). To manage nausea and vomiting, antiemetic medications such as ondansetron can be administered. This will enhance the patient’s overall comfort and well-being. Broad-spectrum antibiotics like ciprofloxacin and metronidazole should be initiated promptly to address potential bacterial infection within the gallbladder. The patient should be referred for a surgical consultation for cholecystectomy, which serves as the definitive treatment for acute cholecystitis. According to Hassler and Jones (2019), laparoscopic cholecystectomy is the preferred surgical approach in most cases.
Conclusion
The comprehensive assessment of DC’s case underscores the importance of precise diagnosis and tailored drug therapy plans in the realm of healthcare. With a strong indication of acute cholecystitis based on her clinical presentation and medical history, our recommended drug therapy plan, encompassing pain management, antiemetics, antibiotics, and a cholecystectomy consultation, aligns with established guidelines for this condition. This case exemplifies the critical role that accurate diagnosis plays in guiding patient care, ensuring timely interventions, and ultimately improving the overall quality of life for individuals like DC. In the pursuit of effective healthcare delivery, a patient-centred approach that integrates diagnosis, treatment, and ongoing monitoring remains essential to achieving the best possible outcomes.
References
Ghlichloo, I., & Gerriets, V. (2023, May 1). Nonsteroidal Anti-inflammatory Drugs (NSAIDs). PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK547742/
Hassler, K. R., & Jones, M. W. (2019, March 22). Laparoscopic cholecystectomy. Nih.gov; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK448145/
Tanaja, J., & Meer, J. M. (2019, January 27). Cholelithiasis. Nih.gov; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK470440/
Zhang, Y., Sun, L., Wang, X., & Chen, Z. (2022). The association between hypertension and the risk of gallstone disease: a cross-sectional study. BMC Gastroenterology, 22(1). https://doi.org/10.1186/s12876-022-02149-5
DC is a 46-year-old female who presents with a 24-hour history of RUQ pain. She states the pain started about 1 hour after a large dinner she had with her family. She has had nausea and on instance of vomiting before presentation.
