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Abstract: Acute cholecystitis has a rapid onset, mostly after meals, and typically presents with epigastric distension and pain, often accompanied by nausea and vomiting. A 26-year-old female patient, who was deeply troubled by this disease, came to our hospital with these symptoms after eating hot pot 3 hours before and continued to worsen. After examination, the diagnosis of acute cholecystitis was confirmed. After 3 days of treatment with anti-inflammatory, antispasmodic, analgesic and acid suppressant drugs, the symptoms improved and the condition was stable.
Basic information】Female, 26 years old
Type of disease】Acute cholecystitis
Hospital】The First Affiliated Hospital of Xi’an Jiaotong University
Date of consultation】January 2020
Treatment plan】Medication (levofloxacin lactate sodium chloride injection, pantoprazole sodium for injection, glucose injection, vitamin C injection, vitamin B6 injection, potassium chloride injection, naproxen sodium for injection, cholinergic tablets)
[Treatment period] Hospitalization for 3 days, long-term follow-up
Treatment effect] Symptoms improved, stable condition
I. Initial consultation
The patient, female, ate hot pot 3 hours ago, then developed paroxysmal epigastric distension and pain, gradually aggravated, accompanied by nausea and vomiting several times, for stomach contents, no chest tightness, no cough and sputum, no diarrhea and anal cessation of defecation and exhaustion, given outside the drug treatment, the specific is not known, the effect is poor, urgent to come to the hospital for consultation. Physical examination: abdomen flat, symmetrical, soft abdomen, no pressure pain, rebound pain, no abdominal mass. The liver and spleen were not palpable under the ribs, and Murphy’s sign was negative. Abdominal percussion showed drum sounds, no percussion pain in the liver and kidney area, and no mobile turbid sounds. The initial diagnosis was acute cholecystitis and gastrointestinal dysfunction, and the patient was admitted to the hospital for treatment and further examination. The patient’s general condition was acceptable and there was no significant weight loss.
Treatment history
The patient was admitted to the hospital and underwent ultrasound of liver, gallbladder, pancreas and spleen, routine blood tests, blood amylase, urine amylase and other related tests. After communicating with the patient, anti-inflammatory, antispasmodic, analgesic and acid suppressant medications were given. The patient was given levofloxacin lactate sodium chloride injection, pantoprazole sodium for injection, glucose injection, vitamin C injection, vitamin B6 injection, potassium chloride injection, naproxen sodium for injection intravenously, and after 3 days the patient recovered well and was discharged from the hospital by arrangement. He was instructed to continue to take cholinesterone tablets after discharge and to come to our hospital for follow-up if he had any uncomfortable symptoms.
III. Treatment effect
Before treatment, the patient had paroxysmal epigastric distension and pain, which gradually worsened, accompanied by nausea and vomiting. On the second day of admission, the epigastric distension and pain disappeared, and physical examination showed no pressure pain and rebound pain in the whole abdomen. On the third day of admission, the patient’s general condition was good. On examination, the patient was clear, in good spirits, sleeping well, eating well, no abnormalities in urination and defecation, and physical examination showed that the abdomen was flat and soft, with no pressure pain and rebound pain.
IV. Notes
After the patient’s condition improved, I was also happy for the patient. In order for the patient to get a better recovery, I did not forget to emphasize to the patient that the following points should be noted in life after discharge.
1. Patients should choose light and easily digestible food in their diet, regular three meals, and no overeating. At the same time, limit the intake of fat, avoid high-salt, high-fat food, so as not to induce disease.
2. patients should pay close attention to their own changes after discharge from the hospital, and if they have symptoms such as abdominal distension, nausea and vomiting after meals, they should go to the hospital promptly.
3, should establish good habits of work and rest, ensure enough sleep, avoid staying up late and overworking.
V. Personal insight
The patient in this case has paroxysmal epigastric distension and pain aggravated by nausea and vomiting as the main symptoms, which are common symptoms of many digestive system diseases and can be easily confused with the following diseases.
1. acute pancreatitis: there is often a history of eating a fatty diet, abdominal pain is usually located in the upper abdomen, and physical examination suggests epigastric pressure pain. ultrasound reveals swelling of the pancreas and elevated blood amylase results. Combined with the patient’s history and examination results, no pancreatic swelling was seen and amylase results were normal, so the diagnosis of malformed pancreatitis could be excluded.
2, upper gastrointestinal perforation: patients often have a history of chronic gastric disease, sudden onset of abdominal pain, rapid manifestations of diffuse peritonitis, physical examination suggests total peritonitis. ultrasound can see a small amount of free fluid in the abdominal cavity, the gallbladder is usually unchanged. The abdominal plain film showed free gas under the diaphragm. Combining the patient’s medical history and examination findings, this diagnosis can be basically excluded.
Therefore, the patient should go to the hospital in a timely manner and be treated under the guidance of a physician to avoid delaying the condition.