A 30yrs Old Lactating Mother of 2months Old Neonate presented to my OPD with Severe Pain Abdomen at Epigastric area & Peri-Umbilical areas.. USG Abdomen & Pelvis Report along with CBP.. Post your Treatment ideas & If possible, comment regarding the aetiological factors for this condition in this case..??
A case of CHOLELITHIASIS with biliary Pancreatitis with Widal positive inn1: 160 titre s of TO antibodies indicative of typhoid carrier as Gall bladder harbours Salmonella typhi bacteria in carriers. A MRCP required to rule out a small calculus in lower CBD causing pancreatitis. Start conservative treatment for Acute Pancreatitis with parenteral antibiotics , IV fluids, pancreatin preparations , Once patient is settled and CBD clearance is done if CBD calculus, an elective laparoscopic cholecystectomy is indicated
Calculus Cholecystitis with pancreatitis with hepatitis.... Obstructive jaundice. Stone CBD.
Calculus cholecystitis with pancreatitis With hepatitis_ obstruction jaundice Stone in CBD NILL BY MOUTH RT Monitor vital, Maintain electrolyte Im balance, IVF RL, DNS, D5% with Inj multivitamins IV Higher Antibiotics Inj metro Inj pan 40mg Inj bascopam / cyclopam Inj voveran sos Inj hepamerz +NS Inj emset Acute onset of pancreatitis is sabside Then ERCP with ENDOSCOPIC BILIARY SPHINCTOTOMY with stenting Clearance of CBD Stone Then after 3 to 4 wks removal of stent And Elective Sx intervention Laproscopic Cholecystectomy
Pt needs to be managed conservatively, maintaining vitals, iv fluids, electrolytes. Antibiotics and pain management Plan choleycystectomy/ lap choley 6 weeks after
Acute cholecystitis and biliary pancreatitis Gall stones may form in pregnancy and peripartum period due to hormone changes Cbd size is normal -maybe passed out cbd stone but if pain is persistent rule out cbd stone -mrcp or ct abdomen Continue antibiotics Plan lap chole. If cbd stone -Ercp
Plz do an MRCP Scan to rule out and Calculus in the CBD leading to Pancreatitis , Hyper Bilirubin and Increase Liver enzymes
My Treatment in this case is NPO/NBM until the suppression of Pain in Abdomen Inj. RL 1000ml Slow IV mixed with MVI Inj. 5% Dextrose 1000ml Slow IV Inj. SULBACEF 1gm IV BD for 5days Inj. METROGYL 100 TID for 5days Inj. PANTAVIB 40 IV BD for 3-5days Inj. DROVIB (Drotaverine) IM SOS.. Patient is Stable now.. Responding well to the Treatment..
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10 year FEMALE PATIENT PRESENT WITH pain ABDOMEN , vomiting , FEVER, CONVULSION SINCE 3- 4 days . USG ABDOMEN AND STRAIGHT XRAY ABDOMEN ERECT POSTURE REPORT ATTACHED. BLOOD REPORT SUGGESTIVE OF NEUTROPHILIC LEUCOCYTOSIS. BLOOD SUGAR, SGPT, SERUM CREATININE, POTASSIUM, CALCIUM, CHLORIDE, MALARIA TEST, QBC IS WITHIN NORMAL LIMIT. SODIUMIS 128, SRUM BILIRUBIN IS 2.46 TOTAL , DIRECT 1.60, INDIRECT 0.86, SERUM AMYLASE IS 264, SERUM LIPASE IS 123, CRP IS 56. PLATELET COUNT IS NORMAL. PROVISIONAL DIAGNOSIS AND TREATMENT. USG REPORT IS BILATERAL MINIMAL ECHOGENIC KIDNEYS, CONTRACTED AND THICK EDEMATOUS GALL BLADDER, MILD ASCITES AND MINIMAL FLUID IN BILATERAL PLEURAL CAVITY, MILDLY DILATED MAIN PANCREATIC DUCT AND MILDLY DILATED CBD AT PORTA, FEW BORDERLINE DILATED GUT LOOPS IN ABDOMEN.
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