Concluded Case

PID Č BULKY UTERUS LEFT OVARIAN HEMORRHAGIC CYST CHOLECYSTITIS

A 46 years old female patient, complaining with pain abdo. RUQ pain also also at supra pubic region, nausea č vomiting, high grade fever č irregular unwanted bleeding, anematic, cacageusia, The pain occurred every 5 to 10 minutes. She is distressed and restless by pain. O/E BP 90 / 60mmHg Pulse 114bpm CVS s1 & s2 P Abdo. Distended Chest B/L clear Edema Temp. 101°F WBC increased 18000 Hb% 6.7, ESR 70 Billirubin 3.8 USG report is submitted hear. Other conservative management are going on BT started. After normalize the situation....we plan for both lap cholecystectomy and open hysterectomy.

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Concluded answer

Respected Dr Maqusud Ansari - At present patient is suffering from Acute cholecystitis with cholelithiasis with Bulky uterus with PID with left haemorrhagic ovarian cyst with severe anaemia,.with septicaemia One should proceed step by step in this case 1.Acute Cholecystitis with positive Murphy 's sign in Indicative of gall bladder wall oedema .It will take another 10 - 12 days before patient is pain free from Cholecystitis. For that she needs NPO , IV fluids,Parenteral antibiotics for 5- 7 days followed by oral antibiotics. After 4- 5 days patient can be put on orals 2.These antibiotics will also take care of PID 3.Laparoscopic cholecystectomy should be done earlier at 6 weeks 4.Meanwhile treat anaemia,Hb - 6.7 with blood transfusions 2 units followed by inj iron -sucrose in 100 ml n.saline drip alternate days to achieve Hb more than 10 gms 5.Now you can plan for hysterectomy

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Respected Dr Maqusud Ansari - At present patient is suffering from Acute cholecystitis with cholelithiasis with Bulky uterus with PID with left haemorrhagic ovarian cyst with severe anaemia,.with septicaemia One should proceed step by step in this case 1.Acute Cholecystitis with positive Murphy 's sign in Indicative of gall bladder wall oedema .It will take another 10 - 12 days before patient is pain free from Cholecystitis. For that she needs NPO , IV fluids,Parenteral antibiotics for 5- 7 days followed by oral antibiotics. After 4- 5 days patient can be put on orals 2.These antibiotics will also take care of PID 3.Laparoscopic cholecystectomy should be done earlier at 6 weeks 4.Meanwhile treat anaemia,Hb - 6.7 with blood transfusions 2 units followed by inj iron -sucrose in 100 ml n.saline drip alternate days to achieve Hb more than 10 gms 5.Now you can plan for hysterectomy

Thank you so much respected dr. Parveen Yograj sir
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SUGGESTIVE OF SEPTICEMIA SEVERE ANEMIA BULKY. UTERUS ACUTE CHOLECYSTITIS CHOLELITHIASIS P. I. D... ADVISABLE... 1. BLOOD. AND. URINE.....C / S 2. B. T.......ALREADY. STARTED 3. TAZOBACTUM+ PIPERACILLIN. ...... ..INFUSIONS 4. REST. AS. PER. TREATMENT. PLAN

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AGAIN COMPLICATED CASE..... YES SUBSIDE THE PROBLEM THEN PLAN FOR SURGERY RESPECTED SIR

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A case of Cholecystitis with Cholelithiasis with Lt hemorrhagic cyst with PID with DUB causing Severe Anaemia,obstructive jaundice secondary to GB calculus with Septicaemia in patient in menopausal age BT already started Inj Piptaz 4.5gm iv 6 hourly Inj Metrogyl 500mg iv 8 hourly Inj Aciloc 50mg iv bd Inj Drotin 40mg im tds Inj Voveran im SOS NPO Slow IV fluid judiciously CBC, ESR, Electrolytes, LFT, BSL routinely as per demands At least 4 units of blood to be transfused every alternate day Inj Jectocoss im deep daily×14days After patient gets stable plan may be taken for LAPCHOLY & Lap overiectomy No need of hysterectomy as the patient is of menopausal age, may be started Medroprogesteron 10mg(Meprate) tds, if still problem of haemorrhagic cyst & control of bleeding persists then think of hysterectomy. Opinion may be taken from Gynaecologist

Welcome Sir
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Doctor please Admit the patient and adv.nil orally and start Injection 10%Glucose +Injection Hepamerz iv bd Injection Monocef 1gm iv bd Injection pan 40 one vial iv OD, Maintain Electrolytes and must do Serum amylase and Lipase first aim should be control Pain and after 15 days plan for Cholecystectomy after corrections of Hb by BT THEN LATER THINK FOR REST

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Cholecystitis with cholelithaisis obstructive jaundice do lft Lt ovarian haemorrhagic cyst at menopausal age settles down of its own in8 weeks Once pt settles for cholestasis jaundice do cholecystectomy

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Congratulations! Your case has been selected as Case of the day and you have been awarded 5 points for sharing the case. Keep posting your interesting cases, Happy Curofying!

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Cholecystitis with Cholelithiasis Bulky uterus Wbc raised too much Anemia needs BT Stabilise Patient then Hysterectomy and cholecystectomy

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Stablize the patient and after covid negative u can go head with lap procedures

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Best of Luck Dear "Dr.Maqusud Sir" Already Respected Doctors Suggested Nicely.

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