- Md. Dulal, a 42-year-old male shopkeeper, presented with 6 months of recurrent upper abdominal pain aggravated by fatty foods. Examination found right hypochondriac tenderness. - Tests showed thickened gallbladder and cholelithiasis on ultrasound. Provisional diagnosis was chronic cholecystitis given recurrent pain related to fatty foods and tenderness in the right upper quadrant. - Differential diagnoses considered were chronic peptic ulcer and pancreatitis but were less likely given absence of hematemesis, melena, or projectile vomiting. Management options discussed were open or laparoscopic cholecystectomy.

1. Good morning & welcome

2. Case presentation on
chronic cholecystitis

3. Particulars of patient
• Name: Md . dulal
• Age: 42 years
• Sex: male
• Marital status: Married
• Religion: Islam
• Address:
charwapda,
khasrhat;
Noakhali
• Date of admission: 16th nov 2017
• Date of examination: 26th nov
2017

4. Chief complaints:
 Recurrent Upper abdominal pain for 6months.

5. History of present illness:
• According to the statement of the patient, he was relatively well 6 month
back since then he developed upper abdominal pain. The pain is colicky,
radiate to back and begins gradually after taking fatty food and relieved by
only taking some painkiller which he couldn’t mention. the pain is
occasionally associated with nausea and non projectile vomiting. He also
gave history of low grade fever during exaggeration of pain. He gave no h/o
itching or blood transfusion. His bowel and bladder habit are normal. He has
no h/o of chest pain, cough, hematemesis, melena, jaundice, dysuria or
marked weight loss.

6. History of past illness
• No h/o HTN, DM, IHD, COPD, previous major medical or surgical
disease is present.

7. Drug history
H/o taking analgesic and PPI but can’t mention name or
group.

8. Family history
• nothing significant

9. Immunization history
• Patient is immunized

10. Occupational history
• He is a shopkeeper.

11. Personal history
• History of smoking 20 pack-year
• No history of alcohol intake
• No specific allergic history is present

12. Socio-economical history
• Patient came from low socio-economical condition

13. General examinations
Appearance Ill looking Thyroid gland Not palpable
Body built Average Dehydration Absent
Nutritional status Average Edema Absent
Co-operation Co-operative Bony tenderness Absent
Decubitus On choice Bp 100/70mmhg
Anemia Absent Pulse 96 bpm
Jaundice Absent Respiratory rate 18
Cyanosis Absent Temperature 99F
Koilonychia Absent Lymph nodes Not palpable
Leukonychia Absent Skin condition Normal; Cannula in
situ at right hand
Clubbing Absent Bed side urine Color straw
JVP Not raised HCT negetive

14. Systemic examinations

15. Gastro-intestinal system
• Inspections
• No mouth ulcer, gum bleeding
• Abdomen is soft, tender at right hypochondrium
• Flank is empty, umbilicus centrally placed, inverted.
• No engorged veins, visible peristalsis is present

16. Palpation:
• Superficial:
-Abdomen is soft, tender over the right hypochondrium, no
muscle guarding, normal
local temperature.
Murphy’s sign: negative
Duodenal point: non tender

17. • Percussion:
• tympanic in the flank.
• Shifting dullness – negative
• Fluid thrill- absent
• Upper boarder of liver dullness in 5th i.c.s at right mid claviculer line
Auscultation:
• Bowel sound- present
• Renal bruit- absent
• No splenic rub or hepatic bruit is present.
DRE: NAD

18. Systemic examinations
Other systemic examinations revealed no abnormalities

19. Salient feature
• Md dulal age 42 years normotensive, non diabetic, smoker muslim
male hailed from char wapda, khaserhat, noakhali admitted to the
hospital through the surgery outdoor at 16th November,2017 with the
complaints of recurrent upper abdominal pain for last six month
which is colicky in nature, radiate to back, aggravated by fatty food
and can’t be relieved without taking analgesics. Pain is sometimes
associated with nausea and non projectile vomiting with low grade
fever during exaggeration of pain. On general examination all findings
are normal and per abdominal examination reveals right
hypochondriac tenderness at level of tip of ninth costal cartilage but
murphy’s sign negative, no duodenal point tenderness or no
organomegaly.

20. Salient features…
• others systemic examination reveals no abnormality

21. Provisional diagnosis
• Chronic cholecystitis
• Points in favor:
• Recurrent upper abdominal pain
• Colicky pain, related to fatty food intake
• Occasionally nausea and vomiting
• Low grade Fever during pain

22. Differential diagnosis:
D/D Points in favor Point against D/D
1. Chronic peptic ulcer Recurrent pain
Occasionally vomiting
No h/o hematemesis, melena
Non projectile vomiting
2. Chronic pancreatitis Recurrent pain
Radiation to back
Colicky pain
Relation to food intake
3.

23. Lab investigations:
• CBC:
• hb%-8.00
• ESR-30
• WBC-13500
• Urinary amylase: normal
• Serum lipase: normal
• X-ray of the abdomen: normal
• USG of W/A.:
• Thickened gall bladder
• cholelithiasis

24. Lab investigations
• Urine R/M/E: nothing significant
• S.creatinine :0.94
• RBS : 5.44
• Hepatic viral markers: not done

25. Management of the patients:
•Cholecystectmy:
•Open
•laparoscopic

26. What is chronic cholecystitis ?
• Chronically inflamed, thickened, non functioning and non
distending gall bladder which is almost always associated
with gall stone

27. Complication of chronic cholecystitis
• CBD stone
• Cholangitis
• Pancreatitis

28. Thank you