Salient Features:

Patient C.P., 66 year old male

Chief complaint: for elective laparoscopic cholestomy
6 mos PTA, patient had repeat Ultrasound, calculous
cholecystitis, bilateral renal corcortical cyts, mild prostate
enlargement with concretions
Past Medical history of hypertension (1986) and mild stroke
(1986)
Previous smoker, stop smoking on 1986
PE: BP 160/80, PR 60, RR 23,

Initial Diagnosis: Chronic Calculus Cholecystitis

Rule in Rule out

Patient C.P., 66 year old
male
Chief complaint: for elective
laparoscopic cholestomy
6 mos PTA, patient had
repeat Ultrasound, calculous
cholecystitis, bilateral renal
corcortical cyts, mild
prostate enlargement with
concretions
Past Medical history of
hypertension (1986) and
mild stroke (1986)
Previous smoker, stop
smoking on 1986
PE: BP 160/80, PR 60, RR 23,
Differential Diagnosis
1. Cholelithiasis
Rule in
Patient C.P., 66 year old
male
Past Medical history of
hypertension (1986) and
mild stroke (1986)
Previous smoker, stop
smoking on 1986
PE: BP 160/80, PR 60, RR 23,
2. Acute Mesenteric Ischemia
Rule in
Patient C.P., 66 year old
male (60 y/o above and
male has high risk)
Past Medical history of
hypertension (1986) and
mild stroke (1986)
Previous smoker, stop
smoking on 1986
PE: BP 160/80, PR 60, RR 23,
3. Acute Pyelonephritis
Rule in
Patient C.P., 66 year old
male (60 y/o above and
male has high risk)
6mos PTA, Ultrasound
showed, mild prostate
enlargement with
concretions
Bilateral renal cortical cysts
Rule out
Chief complaint: for elective
laparoscopic cholestomy
6 months PTA, patient had
repeat Ultrasound, calculous
cholecystitis, bilateral renal
cortical cysts, mild prostate
enlargement with
concretions
Rule out
Chief complaint: for elective
laparoscopic cholestomy
6 months PTA, patient had
repeat Ultrasound, calculous
cholecystitis, bilateral renal
cortical cysts, mild prostate
enlargement with
concretions
Rule out
Chief complaint: for elective
laparoscopic cholestomy
6 months PTA, patient had
repeat Ultrasound, calculous
cholecystitis,
 PE: BP 160/80