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Abstract: The family of 82-year-old Granny Wang told me that Granny Wang had frequent nausea and vomiting in the past half month, and today she started to have fever again. I found the presence of low fever by measuring body temperature, accelerated breathing and heart rate, and positive Murphy’s sign by palpation, and further diagnosed gallstones secondary to cholecystitis after abdominal ultrasound as well as routine blood tests. After more than one month of treatment, Wang’s condition completely improved.
Basic information】Female, 82 years old
Disease Type】Gallstones
Hospital】Shandong Provincial Hospital
Date of Consultation】August 2021
Treatment plan】Medication (dehydrocholic acid tablets, indomethacin enteric tablets, amoxicillin capsules)
Treatment Period】Inpatient treatment for 2 days, return to the hospital for review after 1 month of discharge from the hospital with medication
Treatment effect】The somatic discomfort gradually disappeared, and all the examination indexes tended to be normal
I. Initial consultation
Her family told me that she suddenly developed a persistent fever today and had been experiencing nausea and vomiting for the past half month. Then I asked her family to take her for abdominal ultrasound and routine blood tests. The abdominal ultrasound revealed the presence of bile sludge and stones in the gallbladder and the presence of cysts in the right kidney, which were not serious and could not be treated. The number of leukocytes was found to be significantly elevated by routine blood tests, and the gallbladder stones were considered to be secondary to the presence of cholecystitis.
II. Treatment history
After the diagnosis of gallstones was confirmed, according to the X-ray results, cholesterol stones were found. Considering the small number of stones and the fact that grandmother Wang belonged to an elderly group, she wanted to improve her condition through conservative treatment, so she was planned to use dehydrocholic acid tablets regularly to promote the dissolution of stones and facilitate the discharge of bile. In order to avoid aggravation of cholecystitis, anti-inflammatory and analgesic treatment with indomethacin enteric tablets was administered. After 2 days of hospitalization, it was confirmed that Grandma Wang did not have any adverse reaction to the medication, so she was sent home to continue the medication and return to the hospital for a review in 1 month.
III. Treatment effect
After 2 days of hospitalization, grandmother Wang’s fever, nausea, and vomiting decreased. 1 month after discharge from the hospital, a review revealed that grandmother Wang no longer had fever, nausea, vomiting, and fever, and her heart rate and respiration returned to normal due to relief of somatic discomfort. Ultrasound of the abdomen was performed again and no stones in the gallbladder or bile duct were found. The number of white blood cells was found to be normal through blood routine, and the condition of gallstones and cholecystitis was considered to be well controlled.
IV. Precautions
After receiving treatment with dehydrocholic acid tablets, indomethacin enteric tablets and amoxicillin capsules, Grandma Wang’s palpation, abdominal ultrasound and routine blood tests have all returned to normal, and I am happy for her. However, the cholesterol stones in the bile ducts and gallbladder were caused by poor dietary habits, so care should also be taken to reduce the intake of cholesterol-rich and fatty food intake after discharge, otherwise it will have an impact on the recovery of the bile duct system. Usually, Grandma Wang can go out for sunbathing and walking, which can help relax and help her body recover. If there is nausea and vomiting after eating after discharge, it cannot be ruled out that gallstones or cholecystitis recur, and she needs to return to the hospital again for treatment.
V. Personal insight
Gallstones are a disease of hepatobiliary surgery. It is better for Grandma Wang to be accompanied by her family to the hospital for treatment after she developed gallstones with cholecystitis, because when gallstones are not too many and not too large, the condition can be relieved by regular medication. However, if Grandma Wang does not come to our hospital in time, coupled with her age, eventually, as the stones increase and the bile ducts become obstructed, the damage to her body will be greater and she may have to undergo a cholecystectomy to treat the damage to her body.