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Case Report

Case Report. History A 44-year-old housewife presented to the emergency department with 1-day history of upper abdominal pain and vomiting . The pain came on suddenly, shortly after eating her evening meals. Case Report. Examination

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Case Report

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  1. Case Report History A 44-year-old housewife presented to the emergency department with 1-day history of upper abdominal pain and vomiting. The pain came on suddenly, shortly after eating her evening meals.

  2. Case Report Examination The patient is febrile with a temperature of 99°F and a pulse rate of 116/min. She has tenderness in the RUQ, worsened by placing two fingers beneath the tip of the ninth costal cartilage during inspiration What is the most likely diagnosis? What is the differential diagnosis?

  3. Cholelithiasis Faisal Ghani Siddiqui MBBS; FCPS (GENERAL SURGERY); PG DIPLOMA-BIOMEDICAL ETHICS; MCPS-HPE; FICLS; (MHPE) Head, Surgical Unit-I Professor of Surgery Chairman, Department of Surgery & Director, Department of Medical Education LIAQUAT UNIVERSITY OF MEDICAL & HEALTH SCIENCES faisalghani@lumhs.edu.pk

  4. Cholelithiasis -Objectives By the end of this presentation the final year MBBS students will be able to: • Interpret findings in patients with cholelithiasis • Design management plan for the treatment of patients with gallstones

  5. Cholelithiasis Diagnosis

  6. Diagnosing Cholelithiasis • History • Physical examination • Ultrasound abdomen

  7. Cholelithiasis –History • Asymptomatic; incidentally diagnosed • Pain associated with flatulent dyspepsia • Dull, constant pain • Biliary colic • Complications

  8. Cholelithiasis - Complications • Acute cholecystitis • Mucocoele • Empyema • Perforation and peritonitis • Biliary obstruction • Obstructive jaundice • Acute cholangitis • Acute pancreatitis • Intestinal obstruction (gallstone ileus)

  9. Cholelithiasis –Physical Findings • Jaundice • RUQ Tenderness • Murphy’s sign • Mass

  10. Cholelithiasis -Ultrasonography

  11. Cholelithiasis Treatment

  12. Cholelithiasis -Treatment asymptomatic, incidentally diagnosed gallstones Do nothing!

  13. Cholelithiasis -Treatment • Symptomatic gallstones • If complications develop cholecystectomy!

  14. Cholelithiasis – General Principals of Treatment • ‘Wait and watch’ • Asymptomatic • Cholecystectomy • Symptomatic gallstones • If complications develop

  15. Cholelithiasis –Management of Acute Cholecystitis • NPO • I.V. fluids • Analgesics • Antibiotics • Cholecystectomy • Emergent • Elective

  16. Cholelithiasis –Management of Empyema of Gallbladder • Cholecystostomy, followed by • Cholecystectomy

  17. Case Report History A 44-year-old housewife presented to the emergency department with 1-day history of upper abdominal pain and vomiting. The pain came on suddenly, shortly after eating her evening meals.

  18. Case Report Examination The patient is febrile with a temperature of 99°F and a pulse rate of 116/min. She is found to have tenderness in the RUQ, worsened by placing two fingers beneath the tip of the ninth costal cartilage during inspiration What is the most likely diagnosis?

  19. Probable diagnosis Acute Cholecystitis

  20. Differential Diagnosis • Acute Appendicitis • Perforated peptic ulcer • Acute pancreatitis • Acute pyelonephritis • MI • Right basal pneumonia

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