 |  please explain the answer
|
 
|
| Author | 12 Posts |
nadiabarati
|
A 51-year-old man presents to the emergency department with abdominal pain. He was well until 2 days ago, when he began to experience severe right upper quadrant pain, radiating to the epigastric region. He reports temperatures to 38.3 C (101 F) and some nausea and vomiting. His temperature is now 39.1 C (102.3 F), blood pressure is 130/70 mm Hg, and pulse is 90/min. Physical examination reveals tenderness in his right upper quadrant, with abrupt cessation of inspiration on deep palpation of his right upper quadrant. Which of the following is the most appropriate management for this patient? A. IV fluids and observation
B. IV antibiotics and observation
C. Admission to a surgical service for next day surgery
D. Urgent surgical evaluation for immediate surgery
E. Urgent percutaneous drainage
|
| yasmeen
Forum Guru
Topics: 67
Posts: 936
|
A ITS ACUTE CHOLECYSTITIS
|
| nadiabarati
|
it's acute cholecystitis. But when we decide to give him IV antibiotics and see if it improves and when we go for surgery???
|
| robin082006
Forum Hero
Topics: 471
Posts: 5,125
|
B. IV antibiotics and observation
___________________
The Key to Succeed is Patience.
|
| 92306
Forum Senior
Topics: 14
Posts: 126
|
B. IV antibiotics and observation
|
| Aashi
Forum Moderator
Topics: 112
Posts: 917
|
C. Admission to a surgical service for next day surgery --->surgery is required for this pt, not just OBSERVING the pt---->IV abs and fluids are requiredbut SURGERY is the ultimate
and why not Emergency surgery--->that is coz he is hemodynamically STABLE, if not--->then immediate surgery
GL
Edited by Aashi on 03/24/07 - 11:07 AM
___________________
"Obstacles are those frightful things you see when you take your EYES off your goal."
|
| yasmeen
Forum Guru
Topics: 67
Posts: 936
|
initial managment of acute chole is iv fluids,electrolyte replacement,ng suction and analgesics and most surgeons now also prescribeantibiotics .once condition is stabilised cholecystectomy is planed.
indications of emergency surgery r,
presence of inflammatory mass, detection of gas in biliary tract, generalised peritonitis,development of intestinal obstruction
|
| nadiabarati
|
Aashi you are right as always! I'm wondering how you answer every question correcctly!!
|
| r_albayunen
Forum Senior
Topics: 0
Posts: 218
|
the correct answer is C .. i did this ? on q bank.
|
| ashfaque
Forum Newbie
Topics: 0
Posts: 142
|
ans B) I/V antibiotics and Observation as kaplan says "for acute cholecystitis NPO> I/V fluids and antibiotics "cool down" most cases allow elective cholecystectomy to follow. if they donot respond( as men and diabetics)emrgency cholecystectomy is needed
|
| coolmavs
Forum Elite
Topics: 21
Posts: 327
|
agree with ashfaque...that is what kaplan says. r_albayunen, are you positive that you need admission for next day surgery......I mean are you sure kaplan qbank has the same answer?
___________________
Yeh Zeher bhi, yoon piya hai.....Jaise sharaab ho!!!!
|
| usmle12
Forum Senior
Topics: 19
Posts: 194
|
emergency surgery in acute cholcystitis is always a risk as operating in presence of infection and unless not resolved with i/v fluids n antibiotics its ot done so it must be i/v antibiotics n observation
|
|
| |
| | | | | | | | | | | | |
You don't have permission to post.
|
