Cholecystitis is inflammation of the gall bladder. This is associated with continuous right upper quadrant or epigastric abdominal pain, fever, nausea and vomiting. Patients present with right upper quadrant tenderness, positive Murphy’s sign and tachycardia.
Medications:
- Hospitalize the patient and keep nil by mouth. Give adequate intravenous fluids.
- Inj. Tazcan 4.5g (Piperacillin 4 g, Tazobactum 500 mg) i.v. every 6 hours for 7 days.
- Tab. Buscopan (Hyoscine 10 mg) 1 tablet 4 times a day for abdominal cramps.
- Tab. Calpol (Paracetamol 500 mg) 1-2 tablets 3-4 times a day for fever.
- Tab. Stemetil 5 (Prochlorperazine 5 mg) 1 tablet thrice a day to reduce nausea.
- Consider surgery if patient does not respond to medical management within 48 hours.
- Consider percutaneous cholecystostomy drainage if cholecystectomy is delayed, .
Investigations:
- Complete blood count – to look for raised white cell count.
- Serum electrolytes – to identify and treat electrolyte abnormalities.
- Liver function test – this is impaired in obstructive cases like gall stones.
- Serum lipase, amylase – this is raised in pancreatitis.
- Random blood sugar – raised if diabetes is secondary to pancreatitis.
- Urine routine – can show presence of urobilinogen.
- USG abdomen – to rule out gall stones and evaluate gall bladder for thickening of wall and liver echotexture.
Further referral:
Patient needs to be referred to general surgeon in case of worsening symptoms.