A 45 year old male presents with a tender hepatomegally and USG showing mass in the gallbladder. Total Bilirubin is 44.8 gm and patient requires narcotic analgesic to relieve the pain. CT shows multiple metastasis in both lobes of liver. How would you manage this case? How would you provide him with tender loving care?
I appreciate the response. But my question is what to do with this tender living care. What to do with the pain which is on a scale of 8/10. Can I admin narcotics ? What do others suggest!
No cure. Only supportive care. Biliary drainage (external or external-internal) could be attempted in case of dilatation
I agree with Bencini and Becker. There is no cure. Best palliative treatment is a regime of paracetamol, NSAIDs and morphine derivatives (e.g. oramorph). Our anesthesiologist generally assist in the management of these patients. If the gallbladder distends you can drain it. If major bile ducts occlude you can also drain it.
This patient"s life span is very short.Best option is to releive her from pain with narcotics.As the Bilirubin level is very high,nerve blocks by the anesthetist is not an option.Give her a tender loving care,as she may slip in to Hepato renal failure any time.Drain the biliary system if the ductal system is obstructed if the condition permits.
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