acute cholecystitis

A 50 years old female occupation by daily labour resident of nalgonda.
Chief complaints:- pain in right abdomen since 2 days.
History of presenting illness:-
Patient was apparently asymptomatic 2days back then he developed pain in right upper abdomen which is sudden in onset gradually progressive in nature.
Pain is if pricking type radiating to back.
Aggrvating factors:- food consumption relieved on medication. Burning sensation in epigastric region.
H/o fever since 2 days low grade intermittent associated with chills and rigors.
No h/o vomiting,Loose stools, constipation, burning micturation.
No loss of weight
Past history:-
H/o similar complaints one week ago
Symptoms subsided on using medication.
Not a know case of diabetes htn epilepsy tb asthma thyroid diseases.
Personal history:-
Diet:-mixed
Appetite:-normal
Sleep:-adequate
Bowel and bladder :-regular
Addiction:-no addictions

Family history:-
No relevent family history

General examination:-
Patient is conscious coherent cooperative well oriented to time place and time.
No pallor icterus cyanosis clubbing generalised Lymphadenopathy edema

Vitals:-
Temperature:- afebrile
Pulse rate:- 92beats per minute
Bp:- 120/80
Spo2 :-95%
Grbs :-150mg/dl
Systemic examination:-
Adomen:-
Inspection:-
 abdomen is obese umblicus is cebtral and inverted 
All quadrants of abdomen moving along with respiration
No engorged veins
No visible pulsations

Palpation:-tenderness in epigastric region and right hypochondrium
No local rise of temp
All inspectory findings confirmed
No organomegaly

Percussion:-
Tympanic heard all over abdomen

Ascultation bowel sounds are positive

Cvs:-
S1 s2 heard
Rs:- bilateral air entry present
 Cns:- no focal neuralogical deficits
Investigation:-


 provisional diagnosis:-
Acute cholecystitis
Treatment:-
Inj taxim 1g i.v bd
Inj amikacin 500mg i.v bd
Inj metrogyl 100ml tid
Inj pan 40mg iv od
Inj buscopan im od
Inj pcm 1g iv 
Monitor vitals.

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