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Dalman
MD MBA
- 070070
Present
a case of Cholelithiasis
Patient History
EI
63-year-old
Female
Born
Masakit
ang tiyan
(abdominal pain)
3 years PTA
Sought consult
Diagnosed with cholelithiasis and liver cirrhosis via
ultrasound and CT
Discharged with pain and other unrecalled
medications
Symptoms resolved
No recurrence of symptoms
1 month PTA
Fever, undocumented
Yellowing of skin
Vomiting 1x
Non-projectile, non-bloody, non-bilous
Consult
General:
Cutaneous:
HEENT:
Cardiovascular:
Respiratory:
Genitourinary:
Endocrine:
Muskuloskeletal:
Hematopoietic:
s/p BTL
Not taking any maintenance medications
History
hypertension
No heart disease, cancer, stroke, diabetes,
asthma, or allergies
Owns
a small business
Used to dwell in the rice fields as a kid
Lives with her family
Non-smoker
Occasional alcoholic beverage drinker
No substance abuse
Physical Exam
Icteric
sclerae
Abdomen
Flabby
Direct tenderness RUQ
No murphys sign
No rebound tenderness
General
Survey
distress
Vital
Signs
febrile at 37.9oC
130/80
RR 20 bpm
HR 71 bpm
Height:162cm weight:53kg BMI: 20.2
Skin
Jaundiced
No rashes, hemorrhages, scars
Moist
Head
no lesions
Eyes
icteric sclerae, pink palpebral conjunctiva
pupils 2-3mm
Ears
no discharge, tenderness
Nose
septum medline, moist mucosa
Throat
mouth and tongue moist
no TPC
Neck
no cervical lymphadonapathy
no nuchal rigidity
Chest
adynamic precordium
no heaves, thrills, or lifts, PMI at 5th ICS MCL
regular rate, normal rhythm
no murmurs
Lungs
symmetrical chest expansion, no retractions
clear breath sounds
Abdomen
flat, no scars, no lesions
normoactive bowel sounds
tympanitic on all quadrants
direct tenderness on the RUQ
no Murphys sign
no rebound tenderness
no masses, no organomegally
no psoas, obturator, and Rovsings sign
History
63 year old female
Diagnosed with
cholelithiasis and liver
cirrhosis via ultrasound
and CT, 3 years
RUQ pain of 1 month
Vomiting
Fever, undocumented
Tea-colored urine
No history of trauma
Physical Exam
Jaundiced skin
Icteric sclerae
RUQ tenderness
Febrile at 37.9oC
Cholangitis
Malignancy
Pancreatitis
Appendicitis
Duodenal
ulcer
Diverticulitis
Inflammation
of the gallbladder
95% caused by gallbladder stones
Begins suddenly as stones block the cystic
duct
Presence
Cholesterol
Female,
Serum
CBC
Liver function test
Bilirubin
Lipase
Amylase
Plain
abdominal film
10-15% of cholesterol
50% of pigment stones
Ultrasonography
cholecystography (OCG)
CT scans
Similar findings as in ultrasound
To further characterize complications
Good for detection of intrahepatic stones or
retrograde
cholangiopancreatography (ERCP)
Common hepatic duct
Common bile duct
Pancreatic duct
activites
Presence of prior complication of gallstone
disease
Underlying condition predisposing patient
to increased risk of gallstone complication
Prophylactic cholecystectomy
> 3cm stones
Laparoscopic Cholecystectomy
Shortened hospital stay
Complications 4%
Conversion to laparotomy 5%
Death <0.1%
Bile duct injuries 0.2-0.5%
Dissolution of stones
Ursodeoxycholic
acid
accompanied by extracorporeal
shock waves
Elimination
of obesity
Low cholesterol diet
High fiber, high-calcium diet
Ingestion of meals at regular intervals
Vigorous exercise
Ursodeoxycholic acid
Ryan Em C. Dalman
MD MBA
- 070070