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Acute Cholecystitis

Protocols

Acute Cholecystitis:

Clinical Examination:

1)high temperature (fever)

2)feeling sick.

3)being sick.

4)sweating.

5)loss of appetite.

6)yellowing of the skin and the whites of the eyes (jaundice)

7)a bulge in the tummy.


On Examination:

1.sudden sharp pain in the upper right side of your tummy (abdomen)

that spreads towards your right shoulder.

2.Murphy's sign

3. Temperature -Raise


Investigations: 

1)CBC with ESR -Neutrophilic  [post id="29" title="Leukocytosis"]
2) Urine RME -[post id="114" title="Click"]
3)USG of W/A -[post id="276" title="Click"]
4)Plain  X-ray Abdomen Erect posture A/P view(To exclude perforation)
5.Serum Amylase(to exclude pancreatitis)
6.Liver Function Test
  • Serum Bilirubin
  • SGPT
  • Alkaline phosphatase
  • Prothambin time

Operative purpose: 
1. ECG 
2.X-ray chest P/A  View 
3.RBS
4.Blood grouping & Rh typing
5.Serum Creatine

Hospital Treatment:

💉 Inf Hartsol ([post id="506" title="Hartmann"] (2L)+5% DNS (1L) I/V@30 d/min

💉Inj. Ceftron([post id="398" title="Ceftriaxone"]) (1gm) IV BD

💉Inj. Filmet([post id="406" title="Metronidazole"]) (500mg/100ml) 1 bag IV TDS

💉 Inj. Maxpro([post id="392" title="Esomeprazole"]) (40mg) 1 vial IV BD

💉Inj. Torax ([post id="450" title="Ketorolac"]) (30mg) 1amp 1/M TDS/sos

💉Inj.Nalbun-2([post id="457" title="Nalbuphine"])+💉 Inj. Vergon([post id="505" title="Prochlorperazine"] )(12.5mg)

(severe pain) lamp I/M- stat & sos

If Vomiting

💉Inj.Emistat([post id="509" title="ondansetron"] Stat & SOS

If Renal insufficiency:

💉 Inj.Anadol([post id="453" title="Tramadol"]) (100mg/2ml)

….1 ample I/M OR I/V stat & SOS

 

6. Monitor vitals 

7.Follow-up 


Advice for Surgey(open/Laparoscopic cholecystectomy) After 6 weaks 

Pre-Operative Order:

 

1.Diet: NPO ,TFO

2. Inf. Hartman solution ([post id="506" title="Hartmann"])(1000ml)……10-20 drop/min

 

3.Inj.Ceftron([post id="398" title="Ceftriaxone"]) (1gm) … 1 vial I/V ….stat

 

4. Inj.Sergel ([post id="392" title="Esomeprazole"])(40mg) …1 vial I/V stat

 

5.Inj.Rolac([post id="450" title="Ketorolac"]) (30mg)….1 ample I/M OR I/V stat & SoS

 

6.Clean the operative area .

 

7.send the patient OT table 30 min before operation .

 

8. Counsel the patient party & written consent must be taken.

Post Operative Order:

 

1.Diet: NPO, TFO(Till further order)

 

2.Inf.Hartman ([post id="506" title="Hartmann"])(1L) +

Inf.5%DNS([post id="510" title="DNS"])(1L) +

Inf.5%DA ([post id="511" title="Dextrose "])(1L) ….I/V 30 drop/min.

 

3. Inj.Ceftron([post id="398" title="Ceftriaxone"])  (1gm) … 1 vial I/V ….BD 

 

4. Inj.Sergel ([post id="392" title="Esomeprazole"])((40mg) …1 vial I/V ….BD

 

5.Inj.Filmet([post id="406" title="Metronidazole"])(500mg/100ml)…1 bottle I/V….stat.& TDS

 

6.Inj.Rolac([post id="450" title="Ketorolac"]) (30mg)….1 ample I/M OR I/V stat & TDS 

OR  if any renal problem

Inj.Anadol([post id="453" title="Tramadol"]) (100mg/2ml) ….1 ample I/M OR I/V stat & TDS

 

7.Nalbun-2( Nalbuphine) …1 ample I/M stat 

OR 

Inj.G-Pethidine([post id="456" title="Pethidine"](100mg/2ml)…..1 ample I/M stat

With 

Inj.Vergon( Prochlorperazine) (12.5mg/ml) …1 ample …I/M stat 

 

8.Voltaline ([post id="448" title="Diclofenac"])suppository (50mg) ….1 stick Per rectal –SOS

 

9.Monitor all Vitals…any abnormality then call doctor

Fresh Order:


Diet : Sips of water then liquid then Normal

💊Cap.Denver([post id="399" title="Cefixime"]) (200mg) 1+0+1……...7 দিন

 

💊Tab.Fimet ([post id="406" title="Metronidazole"]) (400mg) 1+1+1………..5 দিন

 

💊Cap.sergel ([post id="392" title="Esomeprazole"]) (20mg) 1+0+1………..14 দিন

 

💊Tab.Rolac ([post id="450" title="Ketorolac"])  (10mg) 1+0+1(after meal) ….5 দিন

 

💊Tab.Rivotril([post id="474" title="Clonazepam"]) (0.5mg) 0+0+1……..15 দিন

 

💊Tab.CEEVIT([post id="466" title="Ascorbic"] Acid)(250mg) 1+0+1……...10 দিন

 

💊Voltaline ([post id="448" title="Diclofenac"])suppository (50mg) ….1 stick Per rectal –SOS

 

if  Constipation:

💊Syp.Avolac ([post id="515" title="Lactulose"])   3-4 Tsf ....TDS


Dressing check on 3rd POD



Discharge Rx:

Diet :  Normal (restriction only allergic food)

💊Cap.Denver([post id="399" title="Cefixime"]) (200mg) 1+0+1……...7 Days

💊Cap.Qcin 9[post id="407" title="Clindamycin"])(300mg)  ...1+0+1.......7 days

💊Tab.Fimet ([post id="406" title="Metronidazole"]) (400mg) 1+1+1………..5 Days

 

💊Cap.sergel ([post id="392" title="Esomeprazole"]) (20mg) 1+0+1………..14 Days

 

💊Tab.Rolac ([post id="450" title="Ketorolac"])  (10mg) 1+0+1(after meal) ….5 Days

 

💊Tab.Rivotril([post id="474" title="Clonazepam"]) (0.5mg) 0+0+1……..15 Days

 

💊Tab.CEEVIT([post id="466" title="Ascorbic"] Acid)(250mg) 1+0+1……...10 Days


if  Constipation:

💊Syp.Avolac ([post id="515" title="Lactulose"])   3-4 Tsf ....TDS


Advice:  Bangla Advice[post id="522" title="click"]


1. Do not do any heavy work

for 2 months.
2. 15 days rest.
3. Do not eat fatty food 
3. Cut the stitches after

the next.....day. use Mupiderm([post id="524" title="Mupirocin"] oint ...BD for 7days