Discussion: Pharmacotherapy for Gastrointestinal and Hepatobiliary Disorders

Discussion: Pharmacotherapy for Gastrointestinal and Hepatobiliary Disorders

Discussion: Pharmacotherapy for Gastrointestinal and Hepatobiliary Disorders

Pharmacotherapy for Gastrointestinal and Hepatobiliary Disorders Sample

The case scenario is of a 46-year-old female patient who presented with a 24-hour history of one-hour postprandial right upper quadrant pain. He is known gout, type II diabetes mellitus, and hypertension patient. My most likely diagnosis for this patient is choledocholithiasis. Choledocholithiasis is caused by the presence of a stone or stones in the common bile duct. Signs and symptoms may be similar to cholelithiasis, also called gallstones. The reasons for choledocholithiasis in this patient are because she has the risk factors and lab results support the diagnosis. Risk factors for stone formation such as a history of oral contraceptive use, female gender, age above 40 (she is 46), and class one obesity (BMI=30.7) are all present in this patient (Wong et al., 2019). Another reason why this patient is most likely having choledocholithiasis and not cholelithiasis is the presence of cholestatic features such as elevated conjugated bilirubin (0.6 mg/dL)

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No medication has been documented to completely cure choledocholithiasis. Definitive treatment is through surgical means (Gelrud & Singh, 2019). However, ursodiol, a gallstone dissolving agent can be sued for symptomatic relief (Papich, 2021). This medication can also be used to prevent gallstone formation in high-risk individuals. In this patient, ursodiol would prevent further stone enlargement and dissolve the preexisting stone in the common bile duct. This medication therapy would be appropriate when surgical methods are not indicated. There are no notable drug-drug interactions between ursodiol and this patient’s medication list. The avoidance of exacerbators of the RUQ pain such as fatty food intake would be avoided. 

Reference

Gelrud, A., & Singh, A. (2019). Pancreaticobiliary Disorders: What Are the Roles of CT, MRCP, and EUS Relative to ERCP? ERCP (Third Edition), 328-334.e2. https://doi.org/10.1016/B978-0-323-48109-0.00034-1

Wong, J. C., Lau, J. Y., & Sung, J. J. (2019). Choledocholithiasis. ERCP (Third Edition), 441-448.e2. https://doi.org/10.1016/B978-0-323-48109-0.00046-8

Papich, M. G. (2021). Ursodiol, Ursodeoxycholic Acid. Papich Handbook of Veterinary Drugs (Fifth Edition), 955-956. https://doi.org/10.1016/B978-0-323-70957-6.00561-6

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Pharmacotherapy for Gastrointestinal and Hepatobiliary Disorders
PHARMACOLOGY

To Prepare
• Review the case study assigned by your Instructor for this Assignment
• Reflect on the patient’s symptoms, medical history, and drugs currently prescribed.
• Think about a possible diagnosis for the patient. Consider whether the patient has a disorder related to the gastrointestinal and hepatobiliary system or whether the symptoms are the result of a disorder from another system or other factors, such as pregnancy, drugs, or a psychological disorder.
• Consider an appropriate drug therapy plan based on the patient’s history, diagnosis, and drugs currently prescribed.
By Day 7 of Week 4
Write a 1-page paper that addresses the following:
• Explain your diagnosis for the patient, including your rationale for the diagnosis.
• Describe an appropriate drug therapy plan based on the patient’s history, diagnosis, and drugs currently prescribed.
• Justify why you would recommend this drug therapy plan for this patient. Be specific and provide examples.

By Day 7 of Week 4
Write a 1-page paper that addresses the following:
• Explain your diagnosis for the patient, including your rationale for the diagnosis.
• Describe an appropriate drug therapy plan based on the patient’s history, diagnosis, and drugs currently prescribed.
• Justify why you would recommend this drug therapy plan for this patient. Be specific and provide examples.

DC is a 46-year-old female who presents with a 24-hour history of RUQ pain. She states the pain started about 1 hour after a large dinner she had with her family. She has had nausea and one instance of vomiting before presentation.
PMH:
HTN
Type II DM
Gout
DVT – Caused by oral BCPs

Vitals:
Temp: 98.8°F
Wt: 202 lbs
Ht: 5’8”
BP: 136/82
HR: 82 bpm
Current Medications:
Lisinopril 10 mg daily
HCTZ 25 mg daily
Allopurinol 100 mg daily
Multivitamin daily

Notable Labs:
WBC: 13,000/mm3
Total bilirubin: 0.8 mg/dL
Direct bilirubin: 0.6 mg/dL
Alk Phos: 100 U/L
AST: 45 U/L
ALT: 30 U/L

Allergies:
Latex
Codeine
Amoxicillin
PE:
Eyes: EOMI
HENT: Normal
GI: Nondistended, minimal tenderness
Skin: Warm and dry
Neuro: Alert and Oriented
Psych: Appropriate mood