PBL 5 session 3

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PBL 5 session 3 by Mind Map: PBL 5 session 3

1. Step 9

1.1. Review session 2

1.2. mechanism flow chart

1.3. 20 minutes

2. Step 10

2.1. Management

2.1.1. goals of manegment

2.1.1.1. stabilize the patient

2.1.1.1.1. ABC's

2.1.1.2. remove stones

2.1.1.2.1. relief the symptoms

2.1.1.3. treat complication

2.1.1.3.1. infection

2.1.2. inetial manegment

2.1.2.1. treatment depend on the complications

2.1.2.1.1. patient need to be hospitalized

2.1.2.2. IV antibiotics

2.1.2.2.1. E.COLI

2.1.2.2.2. third-generation sephalosporins

2.1.2.3. hydration

2.1.2.4. correction of electrolight

2.1.2.5. analgasics for pain relief

2.1.2.5.1. morphen should not be adminstered it increase the tone of sphincter of oddi

2.1.2.6. NPO if planning for surgery

2.1.2.7. IV vitamine K to decrease the INR

2.1.2.8. PATIENT SHOULD BE MONITORED FOR SEPTIC SHOCK

2.1.2.9. diuretics for hypertension and edema

2.1.2.10. IV cck for gallbladder contraction

2.1.2.11. these patient are suciptable for UTI they should be monitored

2.1.2.12. ERCP

2.1.2.12.1. draine the billary tract

2.1.2.12.2. discover obstructive stone and removing them

2.1.2.12.3. ONLY REMOVE STONES IN BILLARY TRACT NOT THE GALLBLADDER

2.1.2.12.4. DIAGNOSTIC

2.1.2.12.5. might cause acute pancrititis

2.1.2.12.6. sphinctrectomy

2.1.2.12.7. early intervention

2.1.2.13. percutanios trans hepatic cholycyctetomy

2.1.2.13.1. for acalculus cholycystitis

2.1.2.13.2. symptomatic tratment in our case

2.1.2.14. cholycyctectomy is contraindicated if

2.1.2.14.1. ESLD

2.1.2.14.2. OBESITY

2.1.3. ongoing management

2.1.3.1. CHOLYCYSTECTOMY

2.1.3.1.1. preOP antibiotics as profilactic

2.1.3.1.2. open

2.1.3.1.3. laproscopic

2.1.3.1.4. usually done within 72 hours after admission

2.1.3.1.5. the procesure is contraindicated if patient have fistula

2.1.3.1.6. post cholycystectomy syndrome

2.1.3.2. disolve stones

2.1.3.2.1. for mild cases

2.1.3.2.2. rarly effective

2.1.3.2.3. they stay on pills for year or motr

2.1.3.3. drainage of the bile

2.1.3.4. OBSERVATION

2.1.3.4.1. diet

2.1.3.5. social worker because she take care of her husband

2.1.3.6. referal to cardiologist

2.2. Prevention

2.2.1. pimary prevention

2.2.1.1. diet

2.2.1.1.1. high calcume

2.2.1.1.2. low in fat high in fibers

2.2.1.2. lose weight slowly

2.2.1.3. excersise

2.2.1.4. avoid skipping meals

2.2.1.5. urosedol

2.2.1.5.1. for patients at high risk

2.2.1.6. avoid oral contraseptive

2.2.2. secondary

2.2.2.1. early detection

2.2.2.2. early treatment

2.3. 60 minutes

3. step 11

3.1. Review and evaluate

3.2. Group members

3.3. Chairman

3.4. Scribe

3.5. Tutor

3.6. Material

3.7. 10 minutes