2. Sarah is 45-year-old female from Saudi presents with a complaint
of abdominal pain for the past 3 days. She localizes the pain to her
epigastric area and states that it radiates to her right upper quadrant.
She notes that it became markedly worse after eating dinner last
night. She recalls a past history of similar pain, but has never had
any diagnostic workup.
Her past medical history is significant for DM II and
hypercholesterolemia. She is status post a total abdominal
hysterectomy 1 year ago.
3. HPI
The pain intermittent since 3 months.
usually last for 30 minutes then subsides gradually and Inc.
with fatty meals.
Nothing relieve it. It became continuous last 3 days.
Severity of pain 6/10
9. PE
overweight woman in no acute distress. Her chest and
cardiovascular exams are normal except for mild tachycardia.
Her abdominal exam is significant for tenderness to palpation
to her epigastric and right upper quadrants without rebound
tenderness.
Bowel sounds are normal.
+ Murphy’s.
13. Management
broad-spectrum antibiotics and supportive therapy → surgical
management with cholecystectomy.
• Analgesia, Fluid and electrolyte correction and Antiemetics
• Abx:
Mild= ceftriaxone - if severe= piperacillin-tazobactam +/- Metro.
14. Surgical management
• Laparoscopic cholecystectomy is usually preferred.
• Timing
• In mild cases: elective cholecystectomy within 24–72 hours
• If complications are present (e.g., gangrene, perforation) or
condition worsens despite conservative therapy →
emergency cholecystectomy
• If high risk of surgical complications and/or critically ill →
emergency percutaneous biliary drainage (e.g., cholecystostomy)
→ follow up with interval surgery when possible.