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Abstract: The patient in this case is a middle-aged woman who presented with epigastric pain 7 days ago, which was especially pronounced after eating, and was accompanied by decreased appetite, nausea, vomiting and other uncomfortable symptoms, and did not improve after self-administration of drugs to promote digestion, so she came to our hospital and was diagnosed with hepatogenic cholecystitis, so she was given medication, and after 2 weeks of hospitalization, the patient improved, but she still needed to continue medication and continued outpatient follow-up.
Basic information】Female, 59 years old
Disease Type】Cholangitis
Hospital】The First Affiliated Hospital of Xi’an Jiaotong University
Date of consultation】April 2022
Treatment plan】Medication (compound glycopyrrolate tablets, entecavir dispersible tablets, furosemide injection, thymidine enteric solution tablets, anti-inflammatory and cholestatic tablets)
Treatment period】Hospitalization for 2 weeks, continuous medication treatment, 3 months follow-up 1 time
Treatment effect】The condition improved and the discomfort disappeared basically
I. Initial consultation
The patient is a 59-year-old female who presented 7 days ago with no obvious cause of epigastric vague pain and discomfort, persistent, without progressive aggravation, and without shoulder and back radiating pain. She had a significant loss of appetite, especially for greasy food, yellow urine with a color like strong tea, nausea, occasional vomiting, non-jetting, about 2-3 times a day, and vomitted the stomach contents. He came to the hospital for further treatment. Ultrasound examination of the liver, gallbladder, pancreas and spleen was performed in the outpatient clinic, suggesting cirrhosis, ascites and multiple strong echogenicity in the liver, and he was diagnosed as hepatogenic cholecystitis, so he was admitted to our department for further treatment.
II. Treatment history
After admission, routine blood and liver and kidney tests were completed, in which ALT, AST and ALP were elevated, and the AST/ALT ratio was >1, suggesting the presence of hepatobiliary disease, which coincided with the abdominal ultrasound results, and the patient’s condition was communicated with the patient and his family. In order to control the development of the disease, it was decided to adopt the method of hepatobiliary treatment first, and the patient was given pharmacological treatment, using compound glycyrrhizin tablets to protect the liver and improve liver function, and entecavir dispersible tablets for anti-viral; using furosemide injection to promote the regression of ascites; as well as applying thymidine enteric solution tablets to enhance the patient’s immune function; and finally applying anti-inflammatory and biliary tablets to relieve the discomfort caused by cholecystitis.
III. Treatment effect
After 2 weeks of drug treatment, the patient’s symptoms of nausea and vomiting disappeared, epigastric pain basically disappeared, appetite increased, and mental status was also better than at the beginning of admission. The liver function, ALT, AST, ALP, etc. have decreased compared with the first admission, and ascites has basically disappeared, which indicates that this treatment plan is effective. However, the patient still needs to continue to take medication for continuous treatment to control the development of cirrhosis and avoid inducing cholecystitis again.
IV. Precautions
After 2 weeks of in-hospital treatment, the patient’s condition improved and all the discomfort symptoms were reduced, so he was very happy. At the same time, I told the patient that this cholecystitis was caused by liver cirrhosis, so in order to avoid its recurrence, he should continue to take drugs such as compound glycyrrhizin tablets to treat liver cirrhosis after discharge; he should also pay attention to reducing the intake of fat in his diet, so he can eat foods with high protein and low fat, such as milk and milk products, fish, skinless chicken breast, etc., to supplement his nutrition and not to put too much burden on his gallbladder and liver; finally Patients should come for a follow-up visit every 3 months after discharge to check the condition of the gallbladder and liver.
V. Personal insight
Cholecystitis is a more common complication of viral hepatitis and cirrhosis. When hepatogenic cholecystitis is diagnosed, the patient usually needs to be treated for both gallbladder and liver diseases, and the specific treatment plan depends on the patient’s symptoms, but it is necessary to actively control the inflammation and limit the development of the disease to avoid cholecystitis becoming chronic, which increases the difficulty of treatment and the patient’s pain.