A 30yrs Old Lactating Mother of 2months Old Neonate presented to my OPD with Severe Pain Abdomen at Epigastric area & Peri-Umbilical areas.. USG Abdomen & Pelvis Report along with CBP.. Post your Treatment ideas & If possible, comment regarding the aetiological factors for this condition in this case..??

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A case of CHOLELITHIASIS with biliary Pancreatitis with Widal positive inn1: 160 titre s of TO antibodies indicative of typhoid carrier as Gall bladder harbours Salmonella typhi bacteria in carriers. A MRCP required to rule out a small calculus in lower CBD causing pancreatitis. Start conservative treatment for Acute Pancreatitis with parenteral antibiotics , IV fluids, pancreatin preparations , Once patient is settled and CBD clearance is done if CBD calculus, an elective laparoscopic cholecystectomy is indicated

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Calculus cholecystitis with pancreatitis With hepatitis_ obstruction jaundice Stone in CBD NILL BY MOUTH RT Monitor vital, Maintain electrolyte Im balance, IVF RL, DNS, D5% with Inj multivitamins IV Higher Antibiotics Inj metro Inj pan 40mg Inj bascopam / cyclopam Inj voveran sos Inj hepamerz +NS Inj emset Acute onset of pancreatitis is sabside Then ERCP with ENDOSCOPIC BILIARY SPHINCTOTOMY with stenting Clearance of CBD Stone Then after 3 to 4 wks removal of stent And Elective Sx intervention Laproscopic Cholecystectomy

Thanks Dr Gauthami B
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Acute cholecystitis and biliary pancreatitis Gall stones may form in pregnancy and peripartum period due to hormone changes Cbd size is normal -maybe passed out cbd stone but if pain is persistent rule out cbd stone -mrcp or ct abdomen Continue antibiotics Plan lap chole. If cbd stone -Ercp

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Calculus Cholecystitis with pancreatitis with hepatitis.... Obstructive jaundice. Stone CBD.

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My Treatment in this case is NPO/NBM until the suppression of Pain in Abdomen Inj. RL 1000ml Slow IV mixed with MVI Inj. 5% Dextrose 1000ml Slow IV Inj. SULBACEF 1gm IV BD for 5days Inj. METROGYL 100 TID for 5days Inj. PANTAVIB 40 IV BD for 3-5days Inj. DROVIB (Drotaverine) IM SOS.. Patient is Stable now.. Responding well to the Treatment..

Your line of treatment is fine
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Plz do an MRCP Scan to rule out and Calculus in the CBD leading to Pancreatitis , Hyper Bilirubin and Increase Liver enzymes

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Admit frcp once ptsettled lipase amylase bilirubin alkaline phosphate

1) R/T aspiration is the first need of the hour as there is sign of paralytic ileus and npo for few days. 2 broad spectrum parenteral antibiotics to cover even salmonella typhi infection., ppi, antiemetics, analgesic sos, sufficient I. V flluids. Once stabilised you can advised operative intervention Later on.

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Cholecystectomy after treatment and relief from pancreatitis.

Gall stone pancreatitis. ERCP

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