A 40years female NIDM patient complaining č pain abdo. Pain at upper quadrant region č nausea and vomiting continue, dark brown urination č yellowish skin. She is also febrile č hypertensive. LFT increased 4.2mg / dl RBS 390mg / dl O/E BP 160/90 mmHg Pulse 90 bpm R/R 22 bpm Chest B/L clear CVS NAD what will be the best management please suggest... Now she is under my management Inj. PPI Tab. Wonsodol Tab. PCM Cap. Ramcor Inj. Palzen Inj. Trambax SOS Tab. Tripride suggest for cholecystectomy but when the patient's condition will be control.

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SUGGESTIVE OF. 1. ANTIBIOTICS 2. PERCUTANEOUS. ... ..... CHOLECYSTOSTOMY... MAYBE. TRIED

Thank you so much respected sir
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It is a case of cholecystitis with gall stone. with jaundice and hypertension and T2DM

Thank you doctor
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Respected Sir I think Cholecystectomy can be harmful in such a condition. Firstly controll RBS,nd other Complications. After that Cholecystectomy be better. Still you r on the rt track. add antihypertensive,antijaundice Medications. Adv:- Lipid profile,ECG,2DEcho. KFT nd further investigations.

Thank you so much respected sir I follow ur suggestion dear sir
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A case of acute cholecystitis with jaundice which most likely is due to medical jaundice like viral hepatitis and not Surgical jaundice as no obstruction in CBD .Evaluate and get liver enzymes and hepatitis A , B and C viral serology done . Hypertension needs to be controlled Considering T2DM with RBS - 390 mg put the patient on insulin to achieve ideal glycemic control. Right now conservative treatment is indicated with antibiotics like Amoxyclav 625 B.D which is safe in jaundice to control cholecystitis. Continue PPI, UDCA . Only once patient is anicteric , pain abdomen is settled, glycemic control is achieved, hypertension is controlled early surgery is indicated mainly after 1 months time because small sized multiple stones can slip in CBD and can cause obstructive jaundice

Thank you doctor
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Pt is diabetic and hypertensive and NIIDM Present bsl is 390 uncontrolled hence needs to shift on insulin Pt is hypertensive and need to put on antihypertensive Lfts are deranged and suggest jaundice Usg suggest cholelithiasis Hence multiple problems needs to manage step by step and subject to cholecystectomy by laproscopy

Thank you so much respected Dr Shivraj sir Your suggestions are always..... No words
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Cholelithiasis with Jaundice

Thank you so much respected mem
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Regarding such case patient and patient attenders need assurance .plan for surgery cholecystectomy .need stabilisation .

Thank you so much respected sir
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A case of cholelithiasis with jaundice with no stone in CBD. Cholecystectomy may be permanent solution after stabilisation of condition of the patient.

Your Suggestions always..... I need respected sir ....thank you so much
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CHOLELITHIASIS JAUNDICE ADVISE FOR SURGERY BUT CONDITIONS SHOULD BE CONTROLLED FIRST . YOUR ANAGEMENT IS BETTER THAN BEST SO CONTINUE DR. MAQUSAD SIR.

Cholecystectomy....is permanent solution of this condition...so advise to operate as early as possible.... after stabilize patient...

Thank you so much respected Dr Dinesh sir
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