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Abstract: Acute cholecystitis is a common acute abdominal condition that is more common in women. In this case, the patient was admitted to the hospital with severe abdominal pain as the main symptom, and was clearly diagnosed with “acute cholecystitis” based on the patient’s symptoms and auxiliary examination.
Basic information】Female, 72 years old
Disease Type】Acute cholecystitis
Hospital】The First Affiliated Hospital of Xi’an Jiaotong University
Time of consultation】September 2019
Treatment plan】Medication (amoxicillin sodium clavulanate potassium for injection, cefuroxime sodium for injection, atropine sulfate injection, lysergic acid for injection)
Treatment Period】3 days of inpatient treatment, 1 month of outpatient follow-up
Treatment effect】The condition improved and was discharged after stabilization
I. Initial consultation
The patient, female, 72 years old, presented with pain and discomfort in the right upper abdomen with no obvious cause 8 hours ago, with paroxysmal colic, no fever, no nausea, no vomiting, no diarrhea, no panic, no shortness of breath, no malaise and no discomfort. He came to our hospital today for further treatment without treatment outside. Physical examination: clear consciousness, flat abdomen, no gastrointestinal type and peristaltic waves, no varices in the abdominal wall veins, soft abdominal wall, positive epigastric pressure pain, no rebound pain, mainly in the right upper abdomen, positive Murphy’s sign, no palpable enlargement of the liver and spleen, no mobile turbid sounds, no percussion pain in the liver and kidney area, normal bowel sounds. The patient was given an abdominal CT examination, which showed dilatation of the intrahepatic bile duct, left and right hepatic ducts, common hepatic duct and common bile duct. Gallbladder inflammation. The initial diagnosis was “acute cholecystitis” and the patient was admitted to our department.
II. Treatment process
After determining the treatment plan, we communicated with the patient and his family, and according to the patient’s condition, due to his age and acute attack, drug treatment should be preferred. After the patient and family agreed to the treatment plan, the patient was given amoxicillin sodium for injection and cefuroxime sodium for injection as intravenous anti-inflammatory treatment, atropine sulfate for injection as intravenous antispasmodic treatment, and lysergic acid for injection to relieve the patient’s pain symptoms.
III. Treatment effect
The patient was admitted for 3 days after drug treatment, with normal temperature, disappearance of pain symptoms, flat abdomen, no gastrointestinal type and peristaltic waves, no varicose abdominal wall veins, soft abdominal wall, light pressure pain in the upper abdomen, mainly in the right upper abdomen, and positive Murphy’s sign. In addition, there was no fever, nausea, diarrhea and other uncomfortable symptoms, and the condition improved, and the patient also complained of no other discomfort. The patient was discharged after consultation with the patient and his family.
IV. Precautions
The patient was discharged after her condition improved, and I was sincerely happy for her. At the same time, I advised the patient to arrange reasonable rest after discharge, pay attention to proper exercise and avoid sitting or lying down for a long time after eating. Daily attention should be paid to a light and easily digestible diet, avoiding spicy and fried foods, such as chili peppers, pepper, fried chicken, etc., eating more vegetables and fruits, and not being too full at each meal, eating less and more often. In addition, attention should be paid to outpatient follow-up within 15 days, regular review of abdominal ultrasound, and timely consultation at the hospital if there is discomfort.
V. Personal insight
After the general anti-infection treatment of acute cholecystitis, although the symptoms are relieved, the local congestion and edema, the anatomical structure is unclear, the gallbladder triangle is difficult to dissect and free, and it is impossible to remove the gallbladder smoothly, and the surgery bleeds a lot, and it is also easy to accidentally injure the neighboring organs. Therefore, conservative treatment should be performed as much as possible in the acute stage. As the patient in this case is in the acute phase of cholecystitis and is older, the risk of surgery is higher, so conservative treatment should be preferred and the recovery effect is better.