The case study concerns DC, a 46-year-old woman with RUQ pain that has lasted 24 hours. The onset of the RUQ pain was roughly 1 hour after having a large family dinner. She reports having nausea and one episode of vomiting. The purpose of this paper is to discuss the patient’s diagnosis and recommend an appropriate medication therapy.
Diagnosis
The likely diagnosis for this patient is Acute Cholecystitis. Gallaher and Charles (2022) define Acute cholecystitis as an acute inflammatory disorder of the gallbladder, usually resulting from gallstone obstruction at the cystic duct. The classic clinical presentation of acute cholecystitis includes acute right upper quadrant (RUQ) pain, fever, and nausea associated with eating (Bridges et al., 2018). Physical exam findings include RUQ tenderness. Diagnostic findings in acute cholecystitis include elevated white blood cell count (WBC), Liver enzymes, and bilirubin levels. The patient has RUQ pain, nausea, and vomiting after eating. She also has an elevated WBC count and Direct and indirect serum bilirubin levels.
Appropriate drug therapy
The recommended drug therapy for DC will comprise analgesics, antiemetics, and IV antibiotics. Ketorolac IV 30 mg STAT dose, followed by 10 mg OO QID, will be recommended to relieve RUQ pain (Mou et al., 2019). The antiemetic of choice will be IV Promethazine 12.5 mg QID to manage nausea and vomiting. IV antibiotics will include Levofloxacin 500 mg IV once daily and Flagyl, 1 g IV loading dose followed by 500 mg IV QID (Markotic et al., 2020).
Conclusion
Cholecystitis mainly develops as a complication of gallstone disease but can occur without gallstones. The patient has positive symptoms of Acute Cholecystitis, including RUQ pain, nausea, vomiting, and elevated WBC and bilirubin. Treatment will include antibiotics, antiemetics, and analgesics.
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References
Bridges, F., Gibbs, J., Melamed, J., Cussatti, E., & White, S. (2018). Clinically diagnosed cholecystitis: a case series. Journal of surgical case reports, 2018(2), rjy031. https://doi.org/10.1093/jscr/rjy031
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