Disorder Related to Gastrointestinal

Based on the provided case study, DC is a 46-year-old female presenting with right upper quadrant (RUQ) pain that started about an hour after a large dinner. She has experienced nausea and one instance of vomiting. Let’s analyze the information provided to form a possible diagnosis and consider an appropriate drug therapy plan.

The patient’s medical history includes hypertension (HTN), type II diabetes mellitus (DM), gout, and a history of deep vein thrombosis (DVT) caused by oral birth control pills (BCPs). Her vital signs are within normal limits, with a temperature of 98.8°F, weight of 202 lbs, height of 5’8″, blood pressure of 136/82, and heart rate of 82 bpm.

The current medications the patient is taking include lisinopril 10 mg daily (an antihypertensive), hydrochlorothiazide (HCTZ) 25 mg daily (a diuretic), allopurinol 100 mg daily (used to treat gout), and a multivitamin. Notable laboratory values show a white blood cell count (WBC) of 13,000/mm3, total bilirubin of 0.8 mg/dL, direct bilirubin of 0.6 mg/dL, alkaline phosphatase (Alk Phos) of 100 U/L, aspartate aminotransferase (AST) of 45 U/L, and alanine aminotransferase (ALT) of 30 U/L.

Based on the patient’s symptoms and medical history, a possible diagnosis could be acute cholecystitis. The RUQ pain that started after a large meal, accompanied by nausea and vomiting, is suggestive of gallbladder involvement. The patient’s risk factors such as female gender, obesity, and a history of DVT caused by oral BCPs can contribute to the development of gallstones, which can lead to cholecystitis. Gout and diabetes mellitus are not typically associated with RUQ pain, but they can contribute to the overall risk profile.

The appropriate drug therapy plan for acute cholecystitis may include the following:

1. Pain Management: Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or diclofenac can be used for pain relief. However, caution should be exercised in patients with renal impairment or a history of peptic ulcers.
2. Antibiotics: Given the possibility of infection in acute cholecystitis, an antibiotic regimen should be considered. A combination of a third-generation cephalosporin (e.g., ceftriaxone) and metronidazole can be prescribed to cover common pathogens.
3. Symptomatic Relief: Antiemetics like ondansetron can be prescribed to alleviate nausea and vomiting.
4. Cholecystectomy: In cases of uncomplicated acute cholecystitis, a cholecystectomy (surgical removal of the gallbladder) is the definitive treatment. A referral to a surgeon should be made for further evaluation and management.
5. Adjustment of Medications: It’s important to review the patient’s current medications, particularly allopurinol, as it can interact with certain antibiotics. Dose adjustments or temporary discontinuation may be necessary.

In addition to drug therapy, lifestyle modifications such as dietary changes, weight loss, and avoiding fatty or greasy foods may be recommended to prevent future episodes of cholecystitis.

It is important to note that this is a hypothetical case study, and a healthcare professional should make a definitive diagnosis and treatment plan based on a comprehensive evaluation of the patient, including further diagnostic tests if required.