A case presentation on Cholelithiasis

1. A CASE PRESENTATION ON
CHOLELITHIASIS
Dr. Muhammad Saleem
PGR G Surgery
Gulab Devi Hospital Lahore

2. Presenting complaint:
A 44 years old female named Fehmida presented in ER with complaint of
Abdominal pain and Vomiting from 1 day.

3. History of presenting complaint:
• Patient was alright 7 days back when she started having pain in Upper abdomen
which was more in RUQ, sudden in onset, sharp, colicky in nature, radiating back,
non shifting, relieved by Analgesics, not associated with fever, increase pain after
eating. For 1 day pain intensity was increased which did not settled with analgesics
Also
• Has history of 4 episodes of vomiting since 1 day, which contain food particles, no
blood or mucus present, non projectile, brownish in color, No history of any
trauma or weight loss

4. General and systemic review:
• General Review: No change in appetite,, sleep pattern or mood . No H/O
weight loss
• SYSTEMIC REVIEW :
• GIT : Abdominal Pain and Vomiting present, No diarrhea ,constipation,
dysphagia, dyspepsia,
• Respiratory system: No cough, stridor, hemoptysis, shortness of breath

5. Contd..
• CNS. : no diplopia, fits or headache, tingling, numbness, visual loss
• Cardiovascular system: no orthopnea/ shortness of breath/ , no
palpitations, chest pain or edema
• Genitourinary system: No dysuria, urinary frequency or urgency, polyuria,
nocturia or hematuria

6. Detailed history:
• Past medical history:. Non diabetic, non hypertensive, no other known
comorbidities
• Past surgical history:. Not significant
• Personal history: Married, 3 children, nonsmoker
• Family history: No history of DM,HTN,IHD,Tb,Asthma
• Medication/Feeding History:. No regular medication taken, normal sleep
and appetite
• Allergies:. No known allergies
• Socioeconomic history: Lower socioeconomic status

7. General physical examination
• A middle aged female lying in bed, alert, well orientated in time and space
and Vitally stable
• No pallor, cyanosis, jaundice, koilonychia, leukonychia, clubbing,, edema ,
distended veins

8. Abdominal Examination findings:
• Inspection: Abdomen was symetrical, no scar marks or striae
• Auscultation: Bowel Sounds audible
• Percussion: no visceromegaly
• Palpation: Abdomen was soft, non distended, mild tenderness in RUQ,
Murphy’s +ve, no mass palpable

9. Systemic examination:
• Respiratory: Normal vesicular breathing, no added sounds
• CNS: GCS 15/15, No focal neurological deficits, normal sensory and motor
function
• CVS: S1+S2 +0
• Genitourinary: No significant findings were noted

10. Differential diagnoses:
• Biliary Colic/Cholecystitis
• Acute Pancreatitis
• Acute Appendicitis
• SAIO

11. Investigations:
• All baselines (CBC, LFTs, RFTs, serum electrolytes, viral markers)
• Serum amylase & lipase
• CXR( PA view)
• USG Abdomen & Pelvis
• Xray Abdomen Erect, Supine
• ECG

12. Ranson Criteria:
At time of admission was 0
• Age: 44 Years
• WBC: 13400
• AST: 29
• Glycemia: 94
• LDH: ….

13. Complete Blood
Count

15. Xray Supine Erect

16. USG
Abdomen

17. MANAGEMENT PLAN:
. After clinical history, examination and investigations,
Final diagnosis of CHOLELITHIASIS with CHOLECYSTITIS was made
and Conservative management was started

18. Conservative Management:
• NPO TFO
• IV Fluids
• IV Antibiotics
• IV Analgesics
• IV PPI

19. Cont…
• After conservative management, Lap Cholecystectomy was planned
• Preoperatively; Anesthesia fitness, Blood grouping and crossmatching,
consent, npo at 12am

20. Operatively;

21. Postoperatively;
• NPO for 6 hours
• IV Fluids
• IV Antibiotics
• IV PPI
• IV Analgesics
• Drain output monitoring
• Vitals monitoring
• Dressing monitoring
• Incentive Spirometry

22. Recovery
• The patient recovered without any complications
• Wound condition remained satisfactory
• Drain was removed on the 2nd postop day
• The patient was discharged on the 2nd postop day with advice for followup
after 7 days
• Histopathology report was awaited