Question

following a very small meal of cereal and juice. The pain and discomfort started in the upper abdomen and progressed to the right side of the abdomen. She tried some soup at noon but vomited about three times. She has really eaten very little since and had only ginger ale on the present date. On the next day, because of the abdominal pain, it happened that she was visiting her cardiologist, Dr. Joseph, and he modified her pacemaker. He also noted the abdominal discomfort and suggested an echo scan of the gallbladder and made arrangements. Nevertheless, with her progressive discomfort, the nurse at her convalescent home sugested that she be seen earlier, and this was done by Dr. Richardson, taking calls for Dr. Stillwater, who admitted her on 04/30/XX. Questioning for other previous similar symptoms is rewarding and there is nothing to suggest jaundice, chills or fever I refer you to the laboratory data obtained to date. She has had a previous lower abdominal surgery in the distant past including total hysterectomy and appendectomy. She carries the disease processes of coronary artery disease with a bypass in 19xx as well as a total hip replacement surgery. She had hypertension and hypothyroidism treated by Dr. Stillwater. She described an allergy to penicillin PHYSICAL EXAMINATION General: Pleasant, alert, elderly female who is quite obese but appearing her approximate chronological age Vital Signs: As noted in the nursing record, essentially afebrile to date. Skin: Clear Lymphatics: Unremarkable HEENT: Ears, nose and throat are clear Chest: Clear Heart: A pacemaker is present in the left upper chest. Breasts: Modest size, no masses. Abdomen: Moderately obese with very tender globular mass in the right upper quadrant. No other organomegaly or masses. Bowel sounds are normal, no bruits Pelvie/Rectal: Within normal limits except the noted soft, yellow-brown stool on the rectal glove. Guaiac negative Extremities: Evidence of previous hip surgery, no edema. There are fair distal pulses. No venous varicosities IMPRESSION: 1. Acute cholecystitis with cholelithiasis. 2. Exogenous obesity 3. Chronic coronary artery disease 4. Hypercholesterolemia, all by history and previously treated 5. Status post total hip replacement surgery. COMMENT: I believe she has acute gallbladder disease until proven otherwise. I recommended that she have open gallbladder surgery with cholangiograms and explained this procedure to her at length including further care and possible postoperative complications. I believe she understands and agrees. Thave also discussed the matter with Dr. Stillwater who feels that she is in the best shape possible at this point, and the surgery will be arranged as soon as the operating schedule permits. I appreciate the opportunity to see this patient in consultation Robert E. Lee, MD 1. 2 What type of surgeries did the patient have in the past? Based on her previous cardiac history and physical examination is there evidence of a cardiovascular component to her abdominal pain? Explain your response What findings on physical examination led the physician to suspect gallbladder disease? What is the diagnosis? Does the physician believe that the patient can tolerate surgery at this time? Based on 4.

Answer 1

1) the patient had a total hysterectomy, appendectomy, had a bypass for coronary artery disease and total hip replacement

2) abdominal pain cant be related to cardiac issues, and they were corrected with surgery, On physical examination, moderately obese with a very tender globular mass in the right upper quadrant was noted so it can lead to some abdominal problems

3)the abdomen moderately obese with a clear tender globular mass in the right upper quadrant, and also the abdominal pain and vomiting.these finding led the physician to suspect gall bladder disease.

4) Acute cholecystitis with cholelithiasis

5) the condition of the patient was explained to the patient including the complications in the post-operative care and she is the best shape possible at this point.

1) Three black calculi eas present within the lumen of the gallbladder and approximately  1.7cm in diameter.

2)The mucosa showed a patchy appearance alternating between red-brown and greenish, which made pathologist conclude that as the presence of purulence present in the mucosa

3)cholecystectomy-acute gangrenous cholecystitis, Lithiasis, Mild chronic cholecystitis

1)Cipro 500mg:-to treat for severe bacterial infections in the stomach and intraabdominal.

Flagyl 500 mg: is an antibiotic effective for anaerobic bacterias and certain parasites, anaerobic bacteria can cause disease in the abdomen

2) Yes, even though the patient had some discomfort in the recovering stage which was corrected and overall remained stable and she was sent home with the prescription of multivitamins and iron tablets.

3)In the discharge diagnosis, it was noticed that the patient had Anemia secondary to blood loss, to correct it Iron tablet was given

4) CBC will be done as an outpatient. it is done to review your overall health, to diagnose medical conditions, to monitor a medical condition, to monitor medical treatment

5)On discharge she was diagoned as

Acute choleecystitis secondary to acute cholelithiasis

Anemia secondary to blood loss

Hypertention

Dehydration