Gallstone Attack

Age: ‍ years old

Gender: ‍malefemale



HISTORY:

Presents with a ‍-‍day history of ‍abdominalRUQepigastricright flankback pain

Onset was ‍gradualsudden, started ‍whileafter ‍

Radiation ‍none to ‍

Rated at ‍012345678910 / 10 ‍

Described as ‍crampingsharp

Pattern ‍persistentintermittent

Episodes last for ‍ ‍, recur ‍ times per ‍

Worsening factors: ‍noneeatingfatty foods

Alleviating factors: ‍none, ‍effectiveineffective



Associated symptoms: *Try using right-click for negatives*

‍nausea

‍vomiting, ‍ episodes ‍per day, ‍, ‍hematemesis

‍fever, up to ‍°, over ‍ ‍hoursdays

‍chills

‍jaundice

‍changes in stools

‍changes in urine color

‍bloating

‍weight loss, ‍ ‍lbskg over ‍ ‍weeksmonths, ‍unintentionalintentional

‍chest pain, ‍retrosternal, ‍aching, ‍on exertionat restwith deep breath, ‍mild

‍shortness of breath



Contributing factors:

‍known gallstones

‍high fat diet

‍low fiber diet

‍pregnancy

‍obesity

no history of: ‍cirrhosis, ‍diabetes

no use of: ‍estrogen therapy

no family history of: ‍gallstones





EXAM:

General appearance: ‍well-appearing, ‍apparent distress

Vital signs: ‍normal, BP ‍, HR ‍, RR ‍, SpO2 ‍ %, Temp ‍°

Neck: ‍normal, ‍lymphadenopathy, ‍, c-spine ‍

Heart: ‍RRR, ‍MRG, ‍normal S1 and S2

Lungs: ‍clear bilaterally, ‍abnormal sounds, ‍retractions

Abdomen: ‍soft, ‍non-tender ‍, ‍non-distended, ‍guarding, bowel sounds ‍normal, ‍, ‍CVA tenderness ‍

Skin: ‍rashlesions on ‍

Extremities: ‍warm, ‍dry, cap refill ‍< 3> 3 sec, pulses ‍intact, ‍edema ‍bilaterally, ‍





ASSESSMENT:

‍Biliary Colic ‍likelysuspectedpossible

DDx: gallstones, cholecystitis, choledocholithiasis, pancreatitis, gastritis, peptic ulcer disease, gastroenteritis, appendicitis, functional abdominal pain, abdominal wall pain, inflammatory bowel disease, irritable bowel syndrome, pyelonephritis, renal colic, kidney stones, myocardial infarction, pneumonia with referred pain, abdominal aortic aneurysm, mesenteric ischemia, herpes zoster, sickle cell crisis





PLAN:

Investigations:

- Blood work: ‍CBC, ‍lytes, ‍creatinine, ‍LFTs, ‍lipase, ‍bilirubin

- Abdominal ultrasound

- CT scan of abdomen

- HIDA scan

- MRCP

- ERCP

Treatments:

- ‍Acetaminophen

- ‍Ibuprofen

- ‍Opioids

- ‍Ceftriaxone, ‍Metronidazole if cholecystitis suspected

- Low fat diet

- Increase fluid intake

- Avoidance of rapid weight loss

Further care:

- Referral to general surgeon

- Referral to gastroenterologist

- Follow-up in ‍ ‍daysweeksmonths

- Return if pain worsens, fever develops, jaundice appears, or if new symptoms develop such as vomiting or changes in stool color

- Referral to ER if severe abdominal pain, severe vomiting, or fever