Cholecystitis

CHOLECYSTITIS 1.

CHIEF COMPLAINT

Cholecystitis 2.

HPI a. Concern: b. Onset•Sudden •Gradual c. Duration: ____

•Recent •A few days •Many days •A few weeks •Many weeks •A few months •Many months •A few years •Many years •Recurrent •N/A. d. Severity: •Mild •Moderate •Severe •Absent •Normal •Increased •Decreased •Stable •No significant change from prior visit. •Details e. Location: Right upper quadrant

f. Radiation:

•The flanks •Intrascapular regions •Right shoulder g. Quality : •Improving •No change •Worsening •Burning pain •Constricting •Crushing •Dull pain •Heavy •Sharp pain •Squeezing •Stabbing h. Frequancy i. Status j. Context k. Aggravated by : l. Relieved by m. Associated Symptoms n. Pertinent Negatives o. Notes 3.

ROS

4.

SYMPTOMS a. Pain in the right upper quadrant b. Vomiting c. Nausea d. Fever e. Shock f. Jaundice

g. Belching h. Diarrhea 5.

HISTORY

a. FAMILY HISTORY •Diabetes •Obesity b. SOCIAL HISTORY •Alcoholism c. PAST MEDICAL HISTORY o Obesity o Rapid weight loss o Drugs o Pregnancy o Cholelithiasis o Sickle cell disease o Salmonella infections o Diabetes mellitus o Myocardial infarction o Total parenteral nutrition d. SURGICAL HISTORY e. CHRONIC CONDITIONS o Cholelithiasis 6. 7. •

• • • •

8.

ALLERGIES PHYSICAL EXAMINATION Physical examination may reveal fever, tachycardia, and tenderness in the RUQ or epigastric region, often with guarding or rebound. A palpable gallbladder or fullness of the RUQ is present Jaundice noted Patients present with diffuse epigastric pain without localization to the RUQ. Murphy sign, which is specific but not sensitive for cholecystitis, is described as tenderness and an inspiratory pause elicited during palpation of the RUQ. SPECIFIC DATA LIKE GRADING

9.

TESTS TO BE ORDERED a. WBC count b. Alkaline phosphatase c. Bilirubin d. Alanine aminotransferase (ALT) e. Aspartate aminotransferase (AST) f. Amylase/lipase assays g. Liver function tests h. CRP (C-reactive protein) i. Urinalysis j. Radiography (without contrast) abdomen k. USG abdomen l. Cholangiography m. Percutaneous transhepatic cholangiography (PTC) n. CT scan o. MRI p. Hepatobiliary scintigraphy q. Endoscopic retrograde cholangiopancreatography (ERCP) r. Endoscopic ultrasound-guided transmural cholecystostomy

10. ASSESSMENT/PLAN •Patient should on bowel rest •Give intravenous hydration treatment •Take liquid or low-fat diet •Nothing by mouth in severe cases •Surgical option-laparoscopic cholecystectomy 11. EDUCATION •Take low fat diet •Take cholesterol diet 12. MEDICATION a. b. c. d. e. f. g. h. i. j.

Meperidine Hydrocodone Acetaminophen Oxycodone Ciprofloxacin Meropenem Imipenem Cilastatin Piperacillin Tazobactam

k. Ampicillin l. Sulbactam m. Metronidazole n. Dicyclomine hydrochloride o. Glycopyrrolate p. Promethazine HCl q. Prochlorperazine (Compazine) r. Mezlocillin s. Cefoxitin t. Gentamicin 13. FOLLOW UP