Intermittent abdminal pain

Chief Complaint A 57 y/o male presents with moderate fever and intermittent abdominal pain for 10 days which increased yesterday at night and become more prominent in left upper quadrant. Vitals Vitals are wnl History No past medical or family history. Examination Physical exam shows severe tenderness in the left quadrant of the abdomen. Investigation Total bilirubin: 3.3 mg/dL, Direct bilirubin: 2.5 mg/dL, AST: 310 u/l, ALT: 320 u/l, and an alkaline phosphatase: 175 u/l. CT shows multiple gallstones and pericholecystic fluid in biliary ductal obstruction & large splenic hematoma. Treatment Need your opinion on the case.

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A case of acute resolving acute cholecystitis with cholelithiasis with obstructive jaundice and a large splenic haematoma. The cause of haematoma needs to be found- either it is due to trauma abdomen or as a part of bleeding diathesis due to hepatic disorder- a reduced PTI or Prolonged INR . There is a danger of large splenic haematoma of sudden rupture and urgent splenectomy may be needed Approach 1.Start Parenteral antibiotics 2 Get PTI and INR tested 3.Inj .Vitamin K- daily for 3- 5 days 4.PARENTERAL ANTIBIOTICS 5.An ERCP and clearance of CBD with CBD stent in place 6 A serial USG - regarding status of splenic haematoma 7.Once Jaundice settles - a plan for laparotomy for cholecystectomy and splenectomy in single sitting

Evidently a c/o obstructive cholelithiasis with cholecystitis and having jaundice Pain in lt hypochondrium 8s bcz of splenic hematoma ?infarct Pt will need urgent surgery for splenectomy simultaneously managing obstructive jaundice with detailed investigations like ct abdomen and diabetic profile Once splenic issue is settled give elective plan of cholecystectomy To manage jaund8ce Electrolyte balance Inj dexamethasone Inj Ceftriaxozone Inj pantaprazole Inj ondestron Inj diclofenac Vitals stable

Thanx dr Kute Ankush
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Obstructive jaundice with cholangitis, along with bleeding disorders and deranged coagulation Adv Check PT PTT and INR, correct underlying coagulation disorders with vitamin K and fresh frozen plasma Check platelet count and correct if there is thrombocytopenia Early ERCP with stenting after stabilisation and correction of coagulation parameters Conservative treatment for spleen hematoma, keep under regular follow up with sonography, keep a watch on rupture, any time patient may need spleenectomy Prepare for spleenectomy, by giving pneumococcal, H. Influenzae and meningococcal vaccination

Ac.Cholecyztitis.. Cholelithiasis...Obstructive Jaundice. Splendid hematoma may be due to injury.. I think this patient must be treated as indoor patient with multi specialities.

? JAUNDICE.. WITH.. GALL BLADDER STONES.. & .. SPLENIC. .HEMATOMA.. NEED'S.. MANAGEMENT FOR.. JAUNDICE.. AND.. SPLENIC HEMATOMA .. NEED'S.. IMMEDIATE SURGICAL INTERVENTION WITH..ITS CAUSE.. SURGICAL INTERVENTION FOR.. GALL BLADDER STONES..

Refer to surgery