ruhighazi
Forum Senior
Topics: 23
Posts: 76
|
Following recovery in the hospital from a fracture of the femur, a 70 year old nursing home female patient develops RUQ abdominal pain & fever. She has tenderness in the right subcostal region. There is evidence of progressive sepsis & hemodynamic instability. The WBC count is 24000. A bedside sonogram confirms the presence of calculous cholecystitis. What should treatmenrt involve?
a)IV antibiotics alone
b)ERCP
c)percutaneous drainage of gallbladder
d)urgent cholecystectomy
e)elective cholecystectomy after 3 months
___________________
Ruhighazi
|
| frontal
Forum Guru
Topics: 53
Posts: 421
|
 Nasty one. It says what does treatment INVOLVE. So, it's certainly not antibiotics ALONE.
Antibiotics + ?. Perhaps percutaneous drainage (c) if inflammation does not subside. Urgent chole seems risky. Cholecystectomy eventually.
|
| achilles
Forum Guru
Topics: 90
Posts: 1,228
|
this is acute cholecystitis.
most cases can be managed with IV fluids, NPO, antibiotics and NG suction.
if they dont respond-->emergency cholecystectomy.
if very sick and in a inoperable condition-->emergency percutaneous transhepatic cholecystostomy as a temporary option.
___________________
" it's not whether you get knocked down, it's whether you get up"
" i have miles to go before i sleep "
|
| achilles
Forum Guru
Topics: 90
Posts: 1,228
|
this question seems tough !
ERCP can also be tried if the stone is in the common bile duct.
___________________
" it's not whether you get knocked down, it's whether you get up"
" i have miles to go before i sleep "
|
| achilles
Forum Guru
Topics: 90
Posts: 1,228
|
for this patient i'll go for C.
___________________
" it's not whether you get knocked down, it's whether you get up"
" i have miles to go before i sleep "
|
| achilles
Forum Guru
Topics: 90
Posts: 1,228
|
eventually cholecystectomy will have to be done in this patient. also chances of recurrences are higher with percutaneous cholecystostomy.
___________________
" it's not whether you get knocked down, it's whether you get up"
" i have miles to go before i sleep "
|
| sunny2
Forum Elite
Topics: 51
Posts: 385
|
To start with A. IV antibiotic, but there cannot be one choice in this question,it seems to be framed for multiple choices
|
| yasmeen
Forum Guru
Topics: 72
Posts: 954
|
C SEEMS TO B REASONABLE OPTION AS ANTIBIOTICS ALONE WON,T SUFFICE .
|
| vuks
Forum Newbie
Topics: 1
Posts: 9
|
I think, because he is 70 years wbc 20000 and "progressive sepsis & hemodynamic instability" definitely C.
If he was... wbc 15000, + Murphy and hemodinamicly stabile, then NPO,IV fluids, antibiotic therapy, and after 3 days cholecystectomy would be appropriate.
|
| ruhighazi
Forum Senior
Topics: 23
Posts: 76
|
the answer is C
___________________
Ruhighazi
|
| msyamp
Forum Fanatic
Topics: 60
Posts: 1,462
|
really good one. percutaneous drainage. woow
___________________
If you think you can You can! If you think you cant you are right again!!
|
|
| |
| | | | | | | | | | | |
Similar forum topics