A case presentation on Cholelithiasis..(gall stones)

1. A Case Presentation On
Cholelithiasis
Presented by
M.Anil Kumar
3361-14-820-009
Pharm.D V year

2. Patient Details:
Name : XXX
Age : 30
Sex : Female
I.p no: 20181213144
Department :Surgery
DOA :2-01-2019

3. Chief complaints:
C/o Pain in abdomen since 1 month.
History of present illness:
Patient was apparently asymptomatic 1month
back and then developed abdominal pain which
was on & off at Right hypochondrial region.

4. PARAMETERS NORMAL RANGE DAY 1 DAY 2 DAY 3
Blood Pressure 120/80mmHg 110/80 110/80 120/70
Pulse Rate 60-80bpm 78 72 73
Physical Examination:
On Stomach Examination:
-Right Hypochondrial Tenderness was Observed.
Provisional Diagnosis:
-Cholelithiasis

5. Lab Investigations:
Complete Blood Picture:
PARAMETERS NORMAL VALUE REPORTED VALUE
Haemoglobin 12-15 gm/dL 10.7
RBC 4.2-5.4 mill /cumm 5.0
WBC 4500-11000 cells/cumm 8,100
Neutrophils 45-75% 58
Lymphocytes 16-46% 43
Eosinophils 0-8% 2
Monocytes 4-11% 7
Random Blood Sugar <140mg/dL 76mg/dL
Erythrocyte Sedimentation Rate <10mm/hr 37

6. Liver Function Tests:
PARAMETERS NORMAL VALUE REPORTED VALUE
Total Bilirubin <1.9 mg/dL 0.3
Direct Bilirubin <0.4 mg/dL 0.1
Alk.phosphatase 36-92 U/L 101
SGPT 0-35 U/L 12
SGOT 0-35 U/L 19
Total protein 6-8 g/dL 7.4
Albumin 3.5-5 g/dL 3.5
Globulin 2.5-3.5 g/dL 3.9
PT-INR 1.1-1.2 1.32
Activated thromboplastin
time
22-35 sec 35

7. Renal Function Tests:
PARAMETERS NORMAL VALUE REPORTED VALUE
Blood Urea 15-30 mg/dL 13
Serum Creatinine 0.5-1.2 mg/dL 0.9
PARAMETERS NORMAL VALUE REPORTED VALUE
SODIUM 135-145 mEq/L 144
PATASSIUM 3.5-5.0 mEq/L 4.5
CHLORINE 96 -106 mEq/L 104
IONIC.CALCIUM 1.15-1.45m.mol/L 1.16
Electrolytes:

8. USG-Abdomen:(Gall Bladder)
contracted Gallbladder
Final Diagnosis:
Cholelithiasis
Impression: Cholelithiasis

9. Drug Treatment Chart:
DRUG NAME GEN.NAME CATEGORY DOSE ROUTE FREQ D
1
A
2
Y
3
S
4 5 6
Tab.AtoZ Cu,mn,zn,Se,Vit-
A,B,C,E,D
vitamin &
mineral
supplement
100mg
PO OD + + + + + +
Inj.Monocef Ceftriaxone cephalosporins 1gm IV BD + + + + + +
Inj.PAN-D Pantoprazole+Domp
eridone
PPI+D2 receptor
antagonist
40mg+30
mg
IV OD + + + + + +
Inj.Buscopan Hyoscine
butylbromide
Anti-spasmodic 1amp IV OD + + + + + +
Tab.Actibile Ursodeoxycholic
acid
Liver protective 30mg PO BD + + + + +

10. SOAP Analysis:
Subjective:
A female patient of age 30 years was admitted in Surgery with the
chief complaints of pain in abdomen since 1month
Objective:
The patient has abnormal levels of ESR,Alk-Phosphatase.
On stomach examination:Hypochondrial tenderness was seen.
USG-Abdomen: Contracted Gallbladder was observed.
Assesment:
From the subjective and objective it is assesed that the patient was
suffering from Cholelithiasis.

11. Planning:
Tab.AtoZ
Class:Vitamin & mineral supplement.
Dose: 100mg.
MOA:It acts on megaloblastic bone marrow to produce a normoblastic marrow; treating vitamin
B12 deficiency; increasing absorption of calcium and phosphorus required for strong bones;
metabolizing carbohydrate thus maintains normal growth.
ADRS: Excessive thirst, back pain, Diarrhea, Failure of bile secretion in the intestine, Allergic
reactions,Debilitation, Constipation ,Bloating,Hives,Breathing problems.
Inj.Monocef
Class:Cephalosporin antibiotic.
Dose: 1gm.
MOA:It inhibits mucopeptide synthesis in bacterial cell wall and causes lysis of bacterial
cellwall.
ADRS: Eosinophilia,neutropenia,Hypersensitivity,thrombophlebitis and pain at injection site.

12. Inj.PAN-D
Class:Proton Pump inhibitor + D2receptor antagonist
Dose:40mg+30mg
Mechanism of action:Pantoprazole-It Suppresses gastric acid secretion by blocking “acid (proton)
pump” within gastric parietal cells.Domperidone-It works by blocking the action of a chemical messenger
in the brain which causes the feeling of nausea and vomiting, as well as increasing the contractions of the
stomach and intestines, allowing food to move more easily through the stomach.
Adverse drug reactions:Rash; erythema multiforme; Stevens-Johnson syndrome, Pharyngitis;
rhinitis;Diarrhea.
Inj.Buscopan
Class:Anti-spasmodic
Dose:1amp
Mechanism of action:Its anticholinergic action exerts a smooth-muscle relaxing/spasmolytic
effect. Blockade of the muscarinic receptors in the GI tract is the basis for its use in the
treatment of abdominal pain secondary to cramping.
Adverse drug reactions: Delusions, somnolence, and inhibition of motor-functions.

13. Tab.Actibile
Class:Liver protective
Dose:30mg
Mechanism of action:The drug reduces cholesterol absorption and is used to dissolve
(cholesterol) gallstones in patients who want an alternative to surgery, shown to exert anti-
inflammatory and protective effects in human epithelial cells of the gastrointestinal tract. It has
been linked to regulation of immunoregulatory responses via regulation of cytokines,
antimicrobial peptides defensins.
Adverse drug reactions:malaise, peripheral edema, pyrexia,abdominal discomfort, abdominal
pain, constipation, diarrhea.

14. Drug Interactions:
Drug-Drug Interactions:
No Drug-Drug Interactions found.
Drug-Food Interactions:
No Drug-Food Interactions found.

15. Pharmacist Intervention:
 Haematinics(Iron+Folic acid) should be added to
the prescription which helps in maintaining the
blood levels in the body.

16. Patient Education:
Diet Related:
 Avoid Saturated fats, like those found in meat, are also harder for your liver to process.
 Unsaturated fats, such as olive oil, can be used in moderation.
 Refined sugar can cause fat buildup in your liver, so opt for foods containing natural
sugars. use agave as a sweetener and look to fruits to satisfy your sweet tooth.
 Reduce your sodium intake by avoiding canned and processed foods.
 Consider adding milk thistle to your routine. You can prepare a fresh tea or eat the seeds
as a snack.
 Opt for fruits like papaya and mango, which are rich in digestive enzymes.

17. Disease Related:
 Avoid smoking & alcohol.
 Exposure to sunlight can reduce the bile acid levels.
 self-hygine should be maintained.
 weight should be maintained normal to avoid high cholesterol formation.
Drug Related:
 Inj.Monocef:Obtain patient history, including drug history and any known allergies.
Note renal impairment and allergy to cephalosporins and penicillins.
 Pantoprazole:IV preparation is only used when patient cannot take tablets and for no
more than 10 days.
 Domperidone:Remind patient to take dose once daily without regard to meals.

18. Thank You