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    An Us Ha 11

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    Sailesh Sankar S
    Marina Okopovna Gidhiyan, a 43-year-old nurse, was admitted to the hospital with abdominal pain, fever, nausea, vomiting, and diarrhea. She was diagnosed with acute cholecystitis based on physical examination findings, laboratory tests showing elevated white blood cells and bilirubin, and ultrasonography revealing a gallstone and fluid/obstruction in the bile ducts. She underwent a laparoscopic cholecystectomy and had an uneventful postoperative recovery. She was discharged five days later with recommendations to monitor the incision site and follow up with antibiotics and pain medication.

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    An Us Ha 11

    Uploaded by

    Sailesh Sankar S
    199 views8 pages
    Marina Okopovna Gidhiyan, a 43-year-old nurse, was admitted to the hospital with abdominal pain, fever, nausea, vomiting, and diarrhea. She was diagnosed with acute cholecystitis based on physical examination findings, laboratory tests showing elevated white blood cells and bilirubin, and ultrasonography revealing a gallstone and fluid/obstruction in the bile ducts. She underwent a laparoscopic cholecystectomy and had an uneventful postoperative recovery. She was discharged five days later with recommendations to monitor the incision site and follow up with antibiotics and pain medication.

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    Marina Okopovna Gidhiyan, a 43-year-old nurse, was admitted to the hospital with abdominal pain, fever, nausea, vomiting, and diarrhea. She was diagnosed with acute cholecystitis based on physical examination findings, laboratory tests showing elevated white blood cells and bilirubin, and ultrasonography revealing a gallstone and fluid/obstruction in the bile ducts. She underwent a laparoscopic cholecystectomy and had an uneventful postoperative recovery. She was discharged five days later with recommendations to monitor the incision site and follow up with antibiotics and pain medication.

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    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    199 views8 pages

    An Us Ha 11

    Uploaded by

    Sailesh Sankar S
    Marina Okopovna Gidhiyan, a 43-year-old nurse, was admitted to the hospital with abdominal pain, fever, nausea, vomiting, and diarrhea. She was diagnosed with acute cholecystitis based on physical examination findings, laboratory tests showing elevated white blood cells and bilirubin, and ultrasonography revealing a gallstone and fluid/obstruction in the bile ducts. She underwent a laparoscopic cholecystectomy and had an uneventful postoperative recovery. She was discharged five days later with recommendations to monitor the incision site and follow up with antibiotics and pain medication.

    Copyright:

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    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    of 8

    PATIENT’S DATA

    NAME OF PATIENT :MARINA OKOPOVNA GIDHIYAN

    AGE :43

    RESIDENTIAL ADDRESS :METHEROLDICHESKAYA 29l2,APPARTMENT NO 5.

    OCCUPATION :NURSE

    PLACE OF WORKING :CHILDREN’S POLYCLINIC NO:1

    DATE OF ADMISSION :17-03-2011

    PATIENT WAS ADMITTED BY :DR.BABILEV

    BLOOD GROUP :B{3RD GROUP}

    RHESUS FACTOR +VE

    CLINICAL DIAGNOSIS
     PRINCIPAL:ACUTE CHOLECYSTITIS
     ACCOMPANYING:NIL
     COMPLICATOINS:NIL
     TYPE OF OPERATION:CHOLECYSTECTOMY
     DATE OF OPERATION:25-03-2011
    PRESENTING COMPLAINTS
    Abdominal pain of constant and severe character in the right upper
    quadrant(epigastrium and right hypochondrium).Accompanied by low
    grade fever(38oC),shock,slight jaundice,ascending
    cholangits(cholangitis is given to the traid of pain of jaundiceand
    fever,sometimes known as “charcots
    traids”),malaise,chills,anorexia,nausea,vomiting ,diarrhea.

    THE ANAMNESIS OF ILLNESS

    On 17th march,at 8in the morning,the patient complainted with an severe


    pain in upper right quardrant and right part below the ribs.This was
    accompanied by vomiting twice in the morning with gastric content and
    bile content,also had nausea,diarrhea.She took some analgestics and
    spasmolytics that had no improvement,so called for ambulance and was
    admitted in hospital.

    THE ANAMNESIS OF LIFE

    No history of communicable diseases(hepatitis,tuberculosis and


    venereal diseases).No history of trauma,hemotransfusion and allergy.No
    habbit of smoking and alcoholism.Normal constitution and growth
    rate.Menstrual cycle normal.No history of previous operation.Patient
    has not undergone abortion.

    ON EXAMINATION
    1)EXTERNAL EXAMINATION

    The patients constitution is normal.normosthenic .Muscle growth is in


    average.Active movements.Symmetrical body constitution.No bone
    deformation or signs of joint pain and disconfiguration.Consciousness is
    not altered.Skin is pallor and turgor is maintained.No scars or
    pigmentary spots were evident.Lymph nodes are normal size and
    palpable.Subcutaneous tissue normal.

    2)RESPIRATORY SYSTEM

    Symmetrical respiratory movement,tactile fremitus shows


    symmetry.Clear pulmonary(resonant)sound in percussion.Lungs border
    are in average.Breathing rate is 20 beats per minutes.During
    auscultation were normal breath sounds,no asymmetry,rhonchi,wheeze
    or abnormal sound.Krenings area is normal.Bronchophony is
    normal.Sctang's and Sobrase test results is good.

    3)CARDIOVASCULAR SYSTEM

    Heart size is in average.Normal configuration.Apex is located in 5th


    intercostals space.No pathologic precordial and epigastric
    pulsation.Tones are clear and rhythmic.Auscultation with normal paired
    sounds.First and second heart sounds showed normal work of cardiac
    muscles and valvular and vascular component.No pathological sounds
    were heard.Pulse is 94 beats per minute(normal beat 60-100 per
    minute).Blood pressure is 150/95(normal is 90-119/60-79).

    4)URINOGENITAL SYSTEM

    Kidneys are not palpable.Normal diuresis.No pain during palpation.No


    pain during micturation.Colour of urine is normal.Pasternetski's sign is
    absent on both sides.

    5)ENDOCRINE SYSTEM

    Average wieght and hieght.Sexual characteristics are normal.Thyroid


    gland is not palpable.No signs of hormonal dysfunction.Negative
    Kerings sign.

    6)MUSCULO-SKELETAL SYSTEM

    Symmetrical musculo-skeletal configuration.No deformations.Active


    movements.Arteries are elastic.Normal filling of blood.No signs of
    varicose.

    7)CENTRAL NERVOUS SYSTEM


    Consciousness is not altered.Patients orientation is also not altered.No
    signs of depression.Intellectual is normal.Pupil reflex is normal.

    STATUS LOCALIS(THE LOCAL STATUS)

    Tongue is dry.Tooth are normal.Mouth odor is normal.Mucus membrane


    of mouth is normal.Pain in right hypochondrium and epigastrium.Gall
    bladder is palpable.Tender right upper quadrant-Murphys sign is
    present.Ortners sign is present-tenderness hand taps at edge of right
    costal arch.Georgeivsky-Myussi's signs(phrenic nerve sign) pain when
    press between edges of sternocleidomastiod.Boas signs increased
    sensitivity below the right scapula (due to phrenic nerve
    irritation).Shetkin-Bloomberg's sign is present(pain after sudden release
    of deep palpation of right upper quadrant).Kalk's sign is present(pain
    during percussion in the area of gallbladder).Kurvuasie's sign is
    present(enlarged,distended gallbladder felt during palpation).Stomach
    is tender in palpation.No pain in stomach percussion.Liver borders are
    normal.Normal dulness in liver percussion.In auscultation of abdomen
    normal peristaltic movement were heard.No rub sound was heard.Spleen
    can't be palpated.

    PRELIMINARY DIAGNOSIS AND ITS SUBSTANTIATION

    According to patient's complaints such as pain in right upper


    quadrant,fever,nausea ,vomiting with bile and stomach contents,liquid
    stool.Fast onset of pain with permanent character.Epigastrial
    tenderness during palpation and tensed muscles on anterior wall of
    abdomen.Positive Murphy's sign,Shetkin-Bloomberg's sign,Ortner's sign
    Georgeivsky-myussi's sign,etc is possible to establish as priliminary
    daignosis acute cholecystitis.
    THE PLAN OF INVESTIGATION
     General blood analysis
     Urine analysis
     Ultrasonography
     Endoscopy
     Abdominal X ray
     Hepatobiliary scintigraphy
    LABORATORY,RADIOLOGICAL,INSTRUMENTAL
    INVESTIGATION
    GENERAL BLOOD ANALYSIS

    Leucocytosis(12,000-15,000cells/mm3) with left shift of formula


    Nuclear rods 8-9
    neutrophilia
    mild elevation of serum bilirubin <4mg/ml,with mild elevation of
    ALP,transaminase and amylase
    GENERAL URINE ANALYSIS
     Colour-yellowish
     Reaction-acidic
     Transparency-complete
     Bilirubin-present
     Protien-present
     Sugar-present
     Ketones-absent
     RBC-absent
     Leucocytes-1-3
    ULTRASONOGRAPHY

    Pathology can be identified.Stone in gall bladder. Pericholecystic fluid


    andobstruction in bile ducts(Mirizzi's syndrome).
    CLINICAL DAIGNOSIS AND JUSTIFICATION

    According to patients complaints(constant pain in right upper


    quadrant,fever,nausea,vomiting,liquid stool,loss of weight and
    appetite),on physical findings(pain increase during movements.tensed
    muscles,Murphy's sign,shetkin-bloomberg's sign,etc)and laboratory
    findings(leucocystosis,neutrophilia,elevated serum bilirubin,etc) is
    possible to determine the clinical diagnosis as acute cholecystis

    PREOPERATIVE SUMMARY

    On 17-03-2011 the patient Marina Okopovna Gidhiyan came to surgery


    department of central city hospital no:1 with the following
    complaints:constant pain right upper quadrant, fever, vomiting, liquid
    stool,nausea,bilirubin and sugar in stools.After physical and clinical
    examination,it was determined the clinical diagnosis of acute chlecystitis

    Examination and observation was done on patient and the recommended


    was treatment is surgically.The patient is aware of possible
    consequences of cholecystectomy and anesthesia.Taking into account the
    possible consequences of cholecystitis,patient consented with
    surgery.Preparation of the patient to the surgery included:stopping of
    eating and drinking before surgery,intravenous trip was given to hydrate
    the patient.Antibiotics were given intravenously to kill bacteria thus
    reduces spreading of infection in abdominal cavity and post operative
    complication in abdomen and wound.

    TREATMENT

    Anesthesia: general anesthesia

    Operation: Laproscopic cholecystectomy


    This method is performed via laproscopy approach or via three small
    incisions with a camera to visualise the area of interest in the
    abdomen.Early treatment avoid complications when conservative
    treatment fails.

    Treatment: antibiotics,IV fluids,analgesia,3rdgeneration cephalosporins


    with good anerobic coverage,2ndgeneration cephalosporin combined
    with metronidazole.

    DAILY REVEIW NOTES

    After surgery patients general condition was good.Patient had no


    fever.Pulse rate and blood pressure is normal.Complaints of pain in
    postoperative wounds.Temperature-36.8oC well hydrated,not pale,not
    dyspnoic.Pulse is 70 beats per min,regular blood volume.Patient
    complaints about weakness,appetite is slowly coming back to
    normal.Micturation is normal,no dysuria,pasternetsky's sign is
    absent.Wound is dry and clean,no sign of inflammation,dressed with
    antiseptics and aseptic bandage.

    DISCHARGE SUMMARY

    The patient Marina Okopovna Gidhiyan was diagnosticated with acute


    cholecystitis based on her complaints various investigations and
    laboratory findings.Operation acute cholecystectomy was done on
    25thMarch.Surgery occured without further complications.patient had no
    symtom of fever,vomiting,dizziness,nausea.Postoperative period was
    uneventfull.Patient recieved antibiotics,intravenous fluid,analgesics.On
    5th day,sutures were removed and patient condition to discharge was
    satisfactory.

    Discharge date:30thMarch.

    RECOMMENDATIONS

    The patient is recommmended to check the incision site.Incision site


    should be dry and not completely closed.If the incisions drains pus or
    blood or the edges are pulling apart,physician should be immediately
    notified.Fever and pain at the site should also to be noted.Patient is told
    to resume normal activities for few days,but it takes 4 to 6 weeks for full
    recovery.Antibiotics and pain medication were prescribed and should be
    taken directed for the recommened period.Patient was told to avoid
    laxative,enema,acetaminophen or ibuprofin,aspirin.Patients diet should
    start from soft then to regular.Vitamins should be added to diet.Skin
    scarring from laproscopic cholecystectomy is minimal.

    LITERATURE(REFERANCES)
     Baily and Loves short practice of surgery-(page no:1122-1126)
     Kumar Cotran Robins(basic pathology)
     Adrian A Indar,Ian J Beckingam(clinical riview)
     Dav Jay S,Manriquies.S.(clinical review)

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