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 20 year old male  came to casuality with complaints of fever since 2 days, epigastric discomfort, nausea,  chest tightness , yellowish discolouration of eyes and urine  since  4 days.

Patient was apparently asymptomatic for 6 days back then had sudden onset of fever , low grade not associated with chillschills and rigor , loose stools , vomitings, pain abdomen, loss of apetite,cold , cough. Went to local rmp and took medication then fever subsided but developed yellow discoloration if eyes and urine. No H/O Malena, blood in the stools, any abdominal surgeries.

Not a k/c/o HTN, DM 2, epilepsy, asthma, cad.

PERSONAL HISTORY :

. Mixed diet
•Loss of appetite
•Sleep adequate
•Bowel and Bladder movements regular
Addictions - none

TREATMENT HISTORY 
 •No Long term treatment.

FAMILY HISTORY 
•Not significant

GENERAL EXAMINATION

•Patient is conscious, coherent and cooperative
•Moderately built and Moderately nourished
•No signs of - Pallor
                       Cyanosis
                       Clubbing
                       Lymphadenopathy 
                       Odema


•Icterus present



VITALS
•Temperature - Afebrile
•PR - 80 bpm
•BP - 110/70 mmHg


SYSTEMIC EXAMINATION
CARDIOVASCULAR SYSTEM
•S1, S2 heard
•No murmurs

RESPIRATORY SYSTEM:
•NVBS heard

CENTRAL NERVOUS SYSTEM:
•Intact
•No focal defect
•No abnormality detected


INVESTIGATIONS :
CBP , CUE , APTT, PT, LFT, SEROLOGY, BLOOD FOR MP TEST ,SERUM CREATININE, SERUM ELECTROLYTES, ULTRASOUND.

CBP:

CUE:


APTT:

PT:
BLOOD FOR M.P STRIP TEST
ANTI HCV ANTIBIODIES
HIV RAPID TEST
HBSAG RAPID TEST
SERUM ELECTROLYTES
SERUM CREATININE
BLOOD PARASITES
ULTRASOUND

LFT 

PROVISIONAL DIAGNOSIS: 
Acute Cholecystitis with Gall Bladder Sludge

TREATMENT GIVEN : 
24/07/21:

INJ Pantop 20mg in 500ml NS IV
T Pantop 40mg po/OD
INJ optineuron 1AMP IN 100ml NS IV/OD
INJ zofer 4mg IV/BD
SYP Cyproheptadine 10ml PO/ID
BP/PR/TEMP 4th hourly
GRBS 12th hourly

25/07/21

INJ OPTINEURON 1 AMP in 100ML NS IV/OD
IVF NS and DNS at 50ml/hr
INJ PANTOP 40mg IV/OD 
INJ ZOFER 4mg IV/SOS
BP/PR/TEMP 12th hourly
GRBS 12th hourly

26/07/21
PT. IS C/C/C , afebrile
BP-  110/70 MMHG
PR- 74 BPM
CVS S1 , S2 HEARD
RS - BAE +; NVBS PRESENT
CNS - NFD
P/A - SOFT , TENDRRNESS IN RIGHT HYPOCHONDRIUM.

INJ OPTINEURON 1 AMP in 100ML NS IV/OD
IVF NS and DNS at 50ml/hr
INJ PANTOP 40mg IV/OD 
INJ ZOFER 4mg IV/SOS
BP/PR/TEMP 12th hourly
GRBS 12th hourly
ALLOW LIQUID DIET

27/7/2021:
PT. IS C/C/C , afebrile
BP-  110/70 MMHG
PR- 74 BPM
CVS S1 , S2 HEARD
RS - BAE +; NVBS PRESENT
CNS - NFD
P/A - SOFT , TENDRRNESS IN RIGHT HYPOCHONDRIUM.

SOFT DIET
INJ. AUGMENTIN 1.2G IV/BD
INJ OPTINEURON 1 AMP in 100ML NS IV/OD
IVF  NS @100ML/HR ,RL @ 100ML/HR DNS OVERNIGHT
INJ. PANTOP 40 MG IV/OD
INJ ZOFER 4mg IV/SOS
T. PCM 500 MG PO/ SOS ( NOT > 2G)
GRBS 12th hourly
AT 6 PM _ STOOLS PASSED AND NO COMPLAINTS OF DECREASED SLEEP AND FEVER. NO SIGNS OF HEPATIC ENCEPHALOPATHY.

28/07/2021:

PT. IS C/C/C , afebrile
BP- 100/60 MMHG
PR- 68 BPM
CVS S1 , S2 HEARD
RS - BAE +; NVBS PRESENT
CNS - NFD
P/A - SOFT , TENDRRNESS IN RIGHT HYPOCHONDRIUM.

SOFT DIET
INJ. AUGMENTIN 1.2G IV/BD
INJ OPTINEURON 1 AMP in 100ML NS IV/OD
IVF NS @100ML/HR ,RL @ 100ML/HR DNS OVERNIGHT
INJ ZOFER 4mg IV/SOS
T. PCM 500 MG PO/ SOS ( NOT > 2G)
GRBS 12th hourly


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