Week 4 Assignment
Case Study
DC is a 46-year-old female who presents with a 24-hour history of RUQ pain. She states the pain started about 1 hour after a large dinner she had with her family. She has had nausea and on instance of vomiting before presentation.
PMH: Vitals:
HTN Temp: 98.8oF
Type II DM Wt: 202 lbs
Gout Ht: 5’8â€
DVT – Caused by oral BCPs BP: 136/82
HR: 82 bpm
Current Medications: Notable Labs:
Lisinopril 10 mg daily WBC: 13,000/mm3
HCTZ 25 mg daily Total bilirubin: 0.8 mg/dL
Allopurinol 100 mg daily Direct bilirubin: 0.6 mg/dL
Multivitamin daily Alk Phos: 100 U/L
AST: 45 U/L
ALT: 30 U/L
Allergies:
Latex
Codeine
Amoxicillin
PE:
Eyes: EOMI
HENT: Normal
GI: Nondistended, minimal tenderness
Skin: Warm and dry
Neuro: Alert and Oriented
Psych: Appropriate mood
To prepare
Review the case study assigned by your Instructor for this Assignment
Reflect on the patient’s symptoms, medical history, and drugs currently prescribed.
Think about a possible diagnosis for the patient. Consider whether the patient has a disorder related to the gastrointestinal and hepatobiliary system or whether the symptoms are the result of a disorder from another system or other factors, such as pregnancy, drugs, or a psychological disorder.
Consider an appropriate drug therapy plan based on the patient’s history, diagnosis, and drugs currently prescribed.
Assignment:
Write a 1-page paper that addresses the following:
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.
Pharmacology
The clinician usually evaluates a patient’s medical history, subjective data, and physical exam results in order to make an accurate diagnosis. Patient DC is a 46-year-old female who presents with a 24-hour history of RUQ pain. Based on her medical history, subjective information, and objective data, the most appropriate diagnosis for DC is acute cholecystitis arising from gallstones. Gallstone is a hepatobiliary condition that is characterized by the presence of cholesterol deposits in the gallbladder of the liver. These deposits (stones) usually affect the flow of bile from the liver when a person consumes large amounts of fatty foods. The gallstones block the cystic duct as the bile is forcefully pushed through the gall bladder. This usually causes pain in the right upper quadrant (RUQ) of the abdomen of the affected person. When the pain lasts for 3 to 4 hours, the condition is called biliary colic. However, prolonged pain that extends beyond 4 hours is a sign of complete cystic duct obstruction which usually causes gallbladder pathology known as acute cholecystitis. The patient’s RUQ pain has persisted for 24 hours and it was triggered by a large dinner. Female gender and diabetes are some of the risk factors for acute cholecystitis that occurs after a fatty meal. Patient DC is a female and she has a history of type 2 diabetes mellitus (Sigmon et al., 2022). Symptoms of acute cholecystitis which are present in the patient include nausea, vomiting, elevated blood levels of white blood cells (WBC), and an increased level of direct bilirubin, aspartate aminotransferase (AST), and alanine aminotransferase (ALT).
The appropriate drug therapy for the patient is oral ursodeoxycholic acid. The rationale for this drug therapy plan is to improve her current symptoms by eliminating their source. For example, the ursodeoxycholic acid will dissolve the gallstones thereby preventing the blockage of the cystic duct (Gutt et al., 2020; Machado et al., 2019). This will help to prevent acute cholecystitis and the RUQ pain she is currently experiencing.
References
Gutt, C., Schläfer, S., & Lammert, F. (2020). The treatment of gallstone disease. Deutsches Arzteblatt International, 117(9), 148–158. https://doi.org/10.3238/arztebl.2020.0148
Machado, F., Castro Filho, H. F., Babadopulos, R., Rocha, H., Rocha, J., & Moraes Filho, M. O. (2019). Ursodeoxycholic acid in the prevention of gallstones in patients subjected to Roux-en-Y gastric bypass1. Acta Cirurgica Brasileira, 34(1), e20190010000009. https://doi.org/10.1590/s0102-865020190010000009
Sigmon, D. F., Dayal, N., & Meseeha, M. (2022). Biliary Colic. [Treasure Island (FL): StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK430772/