5 Jaundice
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Case No.: Date: SUBJECTIVE OBJECTIVE ASSESSMENT PLAN PATIENT EDUCATION PROBLEM 1.VITAL SIGNS 2.LAB TESTS 3.MED.LIST ETIOLOGY OF PROBLEM 1.EVALUATE CURRENT THERAPY FOR PROBLEM 2.EVALUATE NEED FOR THERAPY GOALS FOR TREATMENT OF PROBLEM RECOMMEND 1. DRUG TREATMENT FOR PROBLEM 2. MONITORING PARAMETERS FOR EACH DRUG LISTED 3. FURTHER TESTS FOR PROBLEM IF NEEDED 4. DRUGS TO BE AVOIDED AND WHY JAUNDICE 60 yrs male, was admitted on 24/08/2014 with c/o * Fever, Yellowish coloration of eyes since 22/08/14. * Vomiting * Abdominal Pain PMH: Recently affected with bacterial infection and fever and treated with 1.T. Amoxycillin+ Clavulanic acid 625mg 2.T. Ibuprofen 400mg Vitals: P.R :86/min B.P :130/80 mm of Hg RR : 26 / min Body temperature : 101° F Labs: DAY 1 Hemoglobin 10.39 g/dl ESR 23mm/hr RBC 1.5 m/dl Total count 13700/cum Serum Creatinine 3.5g/dl Total Protein 6.4mg/dl SGOT 69u/l SGPT 80u/l ALP 30.7mu/ml Bilirubin total 3.2mg/dl Current medication: Urso deoxy cholic acid-150 mg Pantoprazole-40mg Paracetmol-500mg Chloroquine-500mg Jaundice is caused by a build-up of bilirubin in the blood and body tissue. That build- up is often due to conditions affecting the liver, such as cirrhosis, hepatitis or gallstones. Certain individuals with hereditary conditions (for example, thalassemia or hereditary spherocytosis) are at an increased risk of developing jaundice from 1. Current treatment with following drugs provides quick recovery of patient from jaundice. a) Urso deoxy cholic acid - Naturally Occurring Bile Acids helps in reduction of Jaundice. b) Paracetamol – antipyretic to control the fever. c) Pantoprazole – Proton pump To reduce the Total bilirubin levels To reduce the fever & abdominal pain To stop the vomiting 1. Urso deoxy cholic acid-150 mg Pantoprazole-40mg Paracetmol-500mg 2. Monitor Live Enzymes with Cephalosporin therapy 3. Liver Function Test – Can be repeated. Abdominal ultrasonography is usually done first; usually, it is highly accurate in detecting extrahepatic obstruction. CT and MRI are alternatives. Unexplained cholestatic jaundice warrants laparoscopy occasionally 4. The cephalosporins in 1. Ask the patient to consume plenty of fluids and following a diet that is low in fat, rich in fruits, vegetables and whole grains can help treat jaundice. . Department of Pharmacy Practice, Sri Venkateswara College of Pharmacy, RVS Nagar, Chittoor-517127 (AP), INDIA
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case study om jaundice
Transcript of 5 Jaundice
Case No.: Date:
SUBJECTIVEOBJECTIVEASSESSMENTPLANPATIENT EDUCATION
PROBLEM
1.VITAL SIGNS2.LAB TESTS3.MED.LIST
ETIOLOGY OF PROBLEM
1.EVALUATE CURRENT THERAPY FOR PROBLEM
2.EVALUATE NEED FOR THERAPY
GOALS FOR TREATMENT OF PROBLEM
RECOMMEND1. DRUG TREATMENT FOR PROBLEM2. MONITORING PARAMETERS FOR EACH DRUG LISTED3. FURTHER TESTS FOR PROBLEM IF NEEDED4. DRUGS TO BE AVOIDED AND WHY
JAUNDICE
60 yrs male, was admitted on 24/08/2014 with c/o * Fever, Yellowish coloration of eyes since 22/08/14.* Vomiting* Abdominal Pain
PMH: Recently affected with bacterial infection and fever and treated with 1.T. Amoxycillin+ Clavulanic acid 625mg 2.T. Ibuprofen 400mg
SH: Alcoholic Vitals:P.R :86/min B.P :130/80 mm of HgRR : 26 / minBody temperature : 101 FLabs:DAY1
Hemoglobin10.39 g/dl
ESR23mm/hr
RBC1.5 m/dl
Total count13700/cum
Serum Creatinine3.5g/dl
Total Protein6.4mg/dl
SGOT69u/l
SGPT80u/l
ALP30.7mu/ml
Bilirubin total3.2mg/dl
Current medication:Urso deoxy cholic acid-150 mgPantoprazole-40mg Paracetmol-500mg Chloroquine-500mgCeftriaxone-1gCefixim-200mgBaclofen-10mgJaundice is caused by a build-up of bilirubin in the blood and body tissue. That build-up is often due to conditions affecting the liver, such as cirrhosis, hepatitis or gallstones.
Certain individuals with hereditary conditions (for example, thalassemia or hereditary spherocytosis) are at an increased risk of developing jaundice from hemolysis.
Individuals who consume alcohol heavily are at an increased risk of developing alcoholic hepatitis, pancreatitis, and cirrhosis leading to jaundice. Here the patient is alcoholic 1. Current treatment with following drugs provides quick recovery of patient from jaundice. a) Urso deoxy cholic acid - Naturally Occurring Bile Acids helps in reduction of Jaundice.b) Paracetamol antipyretic to control the fever.c) Pantoprazole Proton pump inhibitor as the patient c/o abdominal pain.
Need for therapy: No change to current therapy is required except stopping the Use of Baclofen (Anti Spastic)To reduce the Total bilirubin levels
To reduce the fever & abdominal pain
To stop the vomiting
1. Urso deoxy cholic acid-150 mgPantoprazole-40mg Paracetmol-500mg
2. Monitor Live Enzymes with Cephalosporin therapy
3. Liver Function Test Can be repeated. Abdominal ultrasonography is usually done first; usually, it is highly accurate in detecting extrahepatic obstruction. CT and MRI are alternatives. Unexplained cholestatic jaundice warrants laparoscopy occasionally
4. The cephalosporins in general have been associated with little hepatotoxicity and only rare instances of drug induced liver injury due to these agents have been published. A special exception is ceftriaxone, a third generation cephalosporin which, when given parenterally, can cause biliary sludge with symptoms of cholecystitis and cholestatic jaundice. 1. Ask the patient to consumeplenty of fluids and following a diet that is low in fat, rich in fruits, vegetables and whole grains can help treat jaundice..
Key Points Suspect acute viral hepatitis in patients, particularly young and healthy patients, who have acute jaundice, particularly with a viral prodrome. Suspect biliary obstruction due to cancer in elderly patients with painless jaundice, weight loss, an abdominal mass, and minimal pruritus. Suspect hepatocellular dysfunction if aminotransferase levels are>500 U/L and alkaline phosphatase elevationis
