Question

Signs, symptoms, etiology, diagnostic testing, labs, and proposed treatment, of a patient who presents with Cholelithiasis and Cholecystitis

Answer 1

Cholelithiasis is the presence of stones in the gallbladder out of bile components.

Signs and symptoms : usually not noticed. In severe cases crampy pain in the right upper quadrant, back pain between shoulder blades, nausea and vomiting.

Etiology : bile contains too much of cholesterol, too much bilirubin and gallbladder doesn't empty correctly.

Diagnosis: confirmed by ultrasonography with a positive Murphy's sign.

Labs: a routine investigation such as CBC, LFT, LIPID PROFILE.

Proposed treatment: gallstones of cholesterol can be dissolved with ursodeoxycholic acid. The obstruction of bile duct can be relived by endoscopic retrograde sphincterotomy following ERCP. Gall stone can be broken up by extracorporeal shock wave lithotripsy. Finally cholecystectomy.

Cholecystitis

It is the inflammation of gallbladder.

Signs and symptoms : right upper abdomen pain, nausea, vomiting and occasional fever.

Etiology : bacterial infection ( E. Coli, Klebsiella etc), gallstones, severe illness, vasculitis, chemotherapy and a major trauma or burns.

Diagnosis: ultrasound and boas's sign

Lab test: CBC, CRP, TOTAL BILIRUBIN LEVEL, AMINOTRANSFERASES LEVEL.

Treatment : opioids for pain control, antibiotics like piperacillin, tazobactum, metronidazole etc

Symptomatic management for fever nausea and vomiting

Surgery - cholecystectomy.