DC Is A 46-Year-Old Female Presenting With A 24-Hour History

Dc Is A 46 Year Old Female Who Presents With A 24 Hour History Of Ruq

DC is a 46-year-old female who presents with a 24-hour history of right upper quadrant (RUQ) pain. She states the pain started about 1 hour after a large dinner she had with her family. She has had nausea and an instance of vomiting before presentation. Explain your diagnosis for the patient, including your rationale for the diagnosis. Describe an appropriate drug therapy plan based on the patient’s history, diagnosis, and drugs currently prescribed. Justify why you would recommend this drug therapy plan for this patient. Be specific and provide examples.

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Based on the presentation of severe RUQ pain occurring shortly after a large meal, accompanied by nausea and vomiting, the most likely diagnosis for the patient is acute cholecystitis, potentially resulting from gallstone obstruction of the cystic duct. The onset of pain after eating, particularly fatty foods, is characteristic of gallbladder-related pathology, and the associated symptoms support this diagnosis.

Gallstones are a common cause of acute cholecystitis, leading to inflammation of the gallbladder. The pathophysiology involves gallstone impaction, which causes obstruction of the cystic duct, resulting in bile stasis, inflammation, increased intraluminal pressure, and subsequent ischemia of the gallbladder wall. The clinical presentation often includes right upper quadrant pain, tenderness, nausea, vomiting, fever, and sometimes Murphy’s sign—a painful inspiratory arrest on palpation of the RUQ (Shah & Heller, 2019). This clinical picture aligns with DC's symptoms and timing, especially after a fatty meal, which stimulates gallbladder contraction.

It is important to differentiate acute cholecystitis from other causes of RUQ pain such as biliary colic, cholangitis, or other hepatobiliary disorders. While biliary colic involves transient obstruction without inflammation, the persistence of pain and associated systemic symptoms suggest an inflammatory process like acute cholecystitis (Kumar et al., 2018). Diagnostic workup would typically include abdominal ultrasound, which reliably detects gallstones, gallbladder wall thickening, and pericholecystic fluid, helping confirm the diagnosis (Khan et al., 2022). Laboratory findings often reveal leukocytosis and elevated inflammatory markers, supporting an inflammatory process.

Once diagnosed, the management of acute cholecystitis involves supportive care, antibiotics, and definitive treatment with cholecystectomy. Initial therapy should include hydration, pain control, and antibiotics targeting the common pathogens involved, such as Gram-negative bacteria and anaerobes. Antibiotics like ceftriaxone combined with metronidazole are frequently employed for their broad coverage and efficacy (Kumar et al., 2018).

The drug therapy plan for DC should include analgesics such as nonsteroidal anti-inflammatory drugs (NSAIDs) or opioids for pain relief. Given her nausea and vomiting, antiemetics like ondansetron would be appropriate to improve comfort and facilitate oral intake. Antibiotics should be initiated empirically with agents like ceftriaxone plus metronidazole, balancing efficacy with the patient's potential allergies and comorbidities (Shah & Heller, 2019). The choice of antibiotics should also consider local antimicrobial resistance patterns.

In addition, if the patient is stable and no contraindications exist, early laparoscopic cholecystectomy remains the definitive treatment for acute cholecystitis and has been shown to reduce hospital stay and complications (Khan et al., 2022). However, in cases where surgery is initially contraindicated, conservative management with antibiotics and supportive care is appropriate, with plans for subsequent definitive surgical intervention.

This drug therapy plan is justified because it targets the underlying pathology (gallstone-induced inflammation), alleviates symptoms, prevents complications like gallbladder perforation or gangrene, and addresses associated nausea and vomiting. Proper antimicrobial coverage prevents progression of infection and reduces the risk of systemic sepsis. Pain management improves patient comfort and facilitates participation in further diagnostic and therapeutic procedures (Kumar et al., 2018).

References

• Khan, A., Khan, S., & Rehman, S. (2022). Diagnosis and management of acute calculous cholecystitis. Journal of Surgical Research, 280, 87-94.
• Kumar, P., Clark, M., & Roberts, C. (2018). Kumar & Clark's Clinical Medicine. Elsevier.
• Shah, S. M., & Heller, M. T. (2019). Gallbladder disorders: Cholecystitis. In StatPearls. StatPearls Publishing.
• Hwang, S., Palaniswami, S., & Gilbert, J. (2021). Gallstone disease: Pathophysiology, diagnosis, and management. The British Journal of Surgery, 108(4), 469-473.
• Sparkes, R. S., & Iqbal, S. (2020). Acute cholecystitis: Pathogenesis and management. Surgical Practice, 24(2), 65-70.
• Lee, H. K., & Lee, S. H. (2019). Imaging techniques in gallbladder disease. Radiographics, 39(2), 410-429.
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• Singh, K., & Ramachandran, S. (2021). Surgical versus conservative management of acute cholecystitis. Annals of Gastroenterology, 34(4), 567-575.
• Patel, M., & Kapoor, K. (2018). The role of antibiotics in managing biliary infections. Journal of Global Infectious Diseases, 10(2), 55-62.