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Abstract: Gallbladder stones are stones occurring in the gallbladder, mainly cholesterol stones and cholesterol-based mixed stones, and often coexist with acute cholecystitis. In this case, the patient was admitted with upper abdominal pain with nausea, eructation and vomiting as the main symptoms.
Basic information】Male, 73 years old
Type of disease】Gallbladder stones
Hospital】The First Affiliated Hospital of Xi’an Jiaotong University
Date of consultation】June 2021
Treatment plan】Medication (cefoperazone sodium sulbactam sodium for injection, amoxicillin sodium for injection, ibuprofen extended-release capsule, ursodeoxycholic acid capsule)
Treatment period】7 days of inpatient treatment, 1 month of outpatient follow-up
Treatment effect】The condition improved and the discomfort disappeared
I. Initial consultation
The patient, male, 73 years old, was admitted to the hospital 2 days ago with no obvious cause of epigastric pain, accompanied by nausea, eructation and vomiting once, without fever, chills, chest tightness, palpitations, yellow skin staining, abnormal urination and defecation, etc. Today, the symptoms worsened. He reported that he had a history of cardiac stenting one year ago, and was currently taking aspirin enteric tablets orally, and had a past history of “gallbladder stones”. Physical examination: abdomen was flat and symmetrical with softness, epigastric pressure pain, right epigastric pain was obvious, rebound pain was not obvious, and there was no abdominal mass. The liver and spleen were not palpable under the ribs, and Murphy’s sign was positive. There was no percussion pain in the liver and kidney area, and no mobile turbid sounds. Bowel sounds were normal. Abdominal CT examination was given, and the results showed gallbladder inflammation, gallbladder stones of 3 cm, and calcified foci in the spleen. Combining the patient’s condition, medical history and ancillary examinations, the preliminary diagnosis was “gallbladder stone”.
II. Treatment
However, considering that the patient was taking aspirin enteric tablets orally, he was not to undergo surgery for the time being, and was given a notice to perform emergency surgery if necessary. After explaining the reasons with the patient and family, the patient and family agreed to the treatment plan. The patient was given cefoperazone sodium sulbactam sodium for injection and amoxicillin sodium for injection as anti-inflammatory treatment. The patient had epigastric pain and was given ibuprofen extended-release capsules as analgesic treatment. The patient was also given ursodeoxycholic acid capsules for lithotripsy treatment. The patient was advised to drink more water.
III. Treatment effect
After drug treatment, on the seventh day of admission, the patient was generally well, with no pain in the upper abdomen. On physical examination: clear consciousness, mental well, flat, symmetrical and soft abdomen, no pressure pain or rebound pain in the upper abdomen, and no abdominal mass. The liver and spleen were not palpable under the ribs, and Murphy’s sign was positive. There was no percussion pain in the liver and kidney area and no mobile turbid sounds. The patient reported significant reduction in epigastric pain and no other discomfort. The patient can be discharged.
IV. Notes
The patient was discharged after her condition improved, and I was sincerely happy for her. After discharge, the patient was advised to eat a low-fat, low-cholesterol and light diet, and to use foods with high vegetable fiber and cholesterol-lowering effects, such as spinach, radish, soybean, apple, mushroom and fungus, etc. Avoid strenuous activities and heavy physical labor for one month. Take appropriate physical exercise to improve the body resistance. In addition, pay attention to regular ultrasound examination, and follow up immediately if symptoms such as abdominal pain, jaundice and fever appear.
V. Personal insight
Gallbladder stones ≥3 cm usually require surgery clinically, but the patient needs to take oral aspirin enteric tablets due to cardiac stent placement. Aspirin enteric tablets have anticoagulant effect, and if surgical treatment is performed during taking the drug, if bleeding occurs during surgery, it may lead to failure to stop bleeding in time, and the patient may easily suffer from excessive blood loss, which may even lead to death, therefore, the patient should be given symptomatic treatment first before looking for Therefore, patients should be given symptomatic treatment first before looking for other times to perform surgical treatment.