PBL 5 session 2

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PBL 5 session 2 by Mind Map: PBL 5 session 2

1. Step 8

1.1. Diagnostic decision

1.1.1. gallblader stones leading to chronic calculus cholecystitis

1.1.2. E.COLI found in blood

1.1.3. mild dilatation in the CBD

1.1.4. cholengitis

1.2. Mechanism

1.2.1. genatics

1.2.2. the formation of stones

1.2.3. obesity

1.2.4. old age

1.3. Presentation

1.3.1. RUQ pain post prandial

1.3.2. jundice

1.3.3. dark urine

1.3.4. pruritis

1.3.5. pale stool

1.4. Supporting data


1.4.2. elevated liver enzymes

1.4.3. US showed stones in the distal part of the CBD

1.5. 10 minutes

2. Step 7

2.1. Inquiry plan and info gathering

2.1.1. History of presenting complaint pain 10 years intermittent right upper abdominal pain sudden in onset constant and sever last for several hours radiate to the chest wall right scapula it is feelt iter scapular region not relieved by antiacids somtimes assotiated with nousia and vomitting fatty food increase her abdominal pain itching little fever for the last 2 days night sweets no rigors no waight changes dar urine foor the last 2 weeks pale stool

2.1.2. Previous medical / surgical history mild hypertention mild conjistive heart faliure admitted 5 month ago for cardia faliure because she stopped her medication hestrictomy at 50

2.1.3. Drug history / allergy digoxen once daily furosamid twice daily puttasiom 3 times daily enalapril twice daily

2.1.4. Family history her mother had gallstones and her bladder was removed at the age of 45 mother died of colon cancer at the age of 60 father died with heart attack at 65 eldest doughter devoloped gallstones at 40

2.1.5. Social / occupational history primary carrer for her husband no allcohol or smokes

2.1.6. Systemic review hypertension

2.1.7. Physical examination vitals plumb woman pulse 100 irregularly irregular BP 170/100 temp 37.5 RR 23 jundice scratch mark on the dorsal surfance of the forarm abdominal tenderness on the RUQ liver edge can be palpated CV raised JVP APPIX IS PALPBLE lateral to mid clavicular line oscultation mild ankle edema respiratory cripitation of the lung basses

2.1.8. tests results ECG ATRIAL FIBRILLATION left ventricular hypertrophy x-ray cardiomegaly both lungs were normal

2.2. 50 minutes

3. Step 6

3.1. Review session 1

3.2. Report new knowledge

3.2.1. billiary tract obstruction signs and symptoms pathophysiology causes malignancy diagnosis complications

3.2.2. pancreatitis signs and symptoms pathophysiology causes diagnosis

3.3. 30 minutes

3.3.1. The scribe does not have to write in this step!