This document outlines a patient empowerment program discussing fundamentals and generalities in the medical management of right upper quadrant abdominal pain and gallbladder disorders. It describes an upcoming talk on the topic that will provide laypeople with an understanding of clinical diagnosis, causes, and treatment of these conditions. The talk is part of a series of health disorder courses aiming to educate and empower patients.

1. Empowerment
objective - for
laypeople to have an
understanding of the
FUNDAMENTALS and
GENERALITIES in
MEDICAL
MANAGEMENT of
RUQ ABDOMINAL
PAIN and
GALLBLADDER
DISORDERS.
Health Disorder
Course–
Fundamentals
and
Generalities in
Medical
Management
of RUQ
ABDOMINAL
PAIN and
GALLBLADDER
Disorders
May 14, 2022
1400H - 1500H
Via Zoom
RUQ – Right Upper Quadrant

2. Empowerment
objective - for
laypeople to have an
understanding of the
FUNDAMENTALS and
GENERALITIES in
MEDICAL
MANAGEMENT of
RUQ ABDOMINAL
PAIN and
GALLBLADDER
DISORDERS.
Health Disorder
Course–
Fundamentals
and
Generalities in
Medical
Management
of RUQ
ABDOMINAL
PAIN and
GALLBLADDER
Disorders RUQ – Right Upper Quadrant
ROJoson PEP Talk
I have a Patient
Empowerment
Program in which I
like to empower the
lay people or
patients to take
control in the
management of
their health.

3. There are 3 courses
in the PEP Talk.
I completed the Core
Course on October 9,
2021.

4. From October 23,
2021 onwards, I have
been tackling Health
Disorder and Health
Issue Courses. This
may take 3 years or
longer.

5. Empowerment
objective - for
laypeople to have an
understanding of the
FUNDAMENTALS and
GENERALITIES in
MEDICAL
MANAGEMENT of
RUQ ABDOMINAL
PAIN and
GALLBLADDER
DISORDERS.
Health Disorder
Course–
Fundamentals
and
Generalities in
Medical
Management
of RUQ
ABDOMINAL
PAIN and
GALLBLADDER
Disorders RUQ – Right Upper Quadrant
My PEP TALK today
is entitled:
Fundamentals and
Generalities in
Medical
Management of
RUQ ABDOMINAL
PAIN and
GALLBLADDER
Disorders. This is
part of the Health
Disorder Course.

6. Contents of ABDOMINAL DISORDERS
[OVERVIEW]
• What is an abdominal disorder?
• What are the different types of abdominal
disorders?
• What are the causes of abdominal disorders?
• How common are the abdominal disorders?
• Clinical diagnosis of abdominal disorders?
• Paraclinical diagnostic procedures for
abdominal disorders?
• Basic treatment modalities for abdominal
disorders?
Fundamentals and
Generalities in
Medical
Management of
RUQ ABDOMINAL
PAIN and
GALLBLADDER
Disorders
March 19, 2022
1400H - 1500H
Via Zoom
• Abdominal Pain
• Abdominal Mass
• Abdominal Obstruction
• Abdominal Bleeding
• Jaundice

7. Fundamentals and
Generalities in
Medical
Management of
RUQ ABDOMINAL
PAIN and
GALLBLADDER
Disorders
March 26, 2022
1400H - 1500H
Via Zoom
Contents of ABDOMINAL PAIN
[OVERVIEW]
• What is an abdominal pain?
• What are the different types of abdominal
pain?
• What are the causes of abdominal pain?
• How common are the abdominal pain?
• Clinical diagnosis of abdominal pain?
• Paraclinical diagnostic procedures for
abdominal pain?
• Basic treatment modalities for abdominal
pain?

8. Fundamentals and
Generalities in
Medical
Management of
RUQ ABDOMINAL
PAIN and
GALLBLADDER
Disorders
Contents of RLQ ABDOMINAL PAIN
and APPENDICITIS
• What is a RLQ abdominal pain?
• What are the different types of RLQ abdominal
pain?
• What are the causes of RLQ abdominal pain?
• How common are RLQ abdominal pain?
• Clinical diagnosis of RLQ abdominal pain?
• Paraclinical diagnostic procedures for RLQ
abdominal pain?
• Basic treatment modalities for RLQ abdominal
pain?
• Management of APPENDICITIS
April 2, 2022
1400H - 1500H
Via Zoom

9. Fundamentals and
Generalities in
Medical
Management of
RUQ ABDOMINAL
PAIN and
GALLBLADDER
Disorders
Contents of RUQ ABDOMINAL PAIN
and GALLBLADDER Disorders
• What is a RUQ abdominal pain?
• What are the different types of RUQ abdominal
pain?
• What are the causes of RUQ abdominal pain?
• How common are RUQ abdominal pain?
• Clinical diagnosis of RUQ abdominal pain?
• Paraclinical diagnostic procedures for RUQ
abdominal pain?
• Basic treatment modalities for RUQ abdominal
pain?
• Management of GALLBLADDER DISORDERS
May 14, 2022
1400H - 1500H
Via Zoom

10. Fundamentals and
Generalities in
Medical
Management of
RUQ ABDOMINAL
PAIN and
GALLBLADDER
Disorders
Definition of Terms in Title AND Delimitation of
Coverage of Talk:
Fundamentals – simplest and essential facts and
theories which can serve as a basis or foundation
and support for advanced information
Generalities – general statements of info, not
covering specifics and details
Medical Management – diagnosis and treatment
by physicians

11. Fundamentals and
Generalities in
Medical
Management of
RUQ ABDOMINAL
PAIN and
GALLBLADDER
Disorders
• What is a RUQ abdominal pain?

12. Fundamentals and
Generalities in
Medical
Management of
RUQ ABDOMINAL
PAIN and
GALLBLADDER
Disorders
• What is a RUQ abdominal pain?
RUQ stands for right upper quadrant.
RUQ abdominal pain means pain or unpleasant
sensation in the right upper quadrant of the
abdomen. RUQ is the location of the pain.
What is the
implication of the
RUQ abdominal
pain?
All the tissues and
organs in the RUQ
area could be the
source of the RUQ
abdominal pain.
• Abdominal wall
• Peritoneal lining
• Internal
abdominal organs
in the area

13. Fundamentals and
Generalities in
Medical
Management of
RUQ ABDOMINAL
PAIN and
GALLBLADDER
Disorders
• What are the different types of RUQ abdominal
pain?

14. Fundamentals and
Generalities in
Medical
Management of
RUQ ABDOMINAL
PAIN and
GALLBLADDER
Disorders
• What are the different types of RUQ abdominal
pain?
Essentially, the different types of RUQ abdominal
pain will be based on the origin of the unpleasant
sensation on/in the area:
• abdominal wall
• lining of the abdominal cavity or
peritoneum
• solid organs
• hollow organs inside the abdominal
cavity in the RUQ

15. Fundamentals and
Generalities in
Medical
Management of
RUQ ABDOMINAL
PAIN and
GALLBLADDER
Disorders
• What are the different types of RUQ abdominal
pain?
Essentially, the different types of RUQ abdominal
pain will be based on the origin of the unpleasant
sensation on/in the area:
• abdominal wall
• lining of the abdominal cavity or
peritoneum
• solid organs
• hollow organs inside the abdominal
cavity in the RUQ
ROJoson GENERAL
CLASSIFICATION OF
TYPES of unpleasant
sensation that can
used as CUES:
• Abdominal wall –
constant,
superficial
• Peritoneal lining –
constant, deeper
• Sold organs –
constant, deep
• Hollow organs –
crampy or colicky

16. Fundamentals and
Generalities in
Medical
Management of
RUQ ABDOMINAL
PAIN and
GALLBLADDER
Disorders
• What are the causes of RUQ abdominal pain?

17. Fundamentals and
Generalities in
Medical
Management of
RUQ ABDOMINAL
PAIN and
GALLBLADDER
Disorders
• What are the causes of RUQ abdominal pain?
All the tissues and organs in the RUQ area could
be the source of the RUQ abdominal pain.
• Abdominal wall
• Peritoneal lining
• Internal abdominal organs in the area (hollow
and solid organs)
• Liver
• Gallbladder
• Pancreas
• Right colon (ascending colon)
• Small intestines
• Right kidney

18. Fundamentals and
Generalities in
Medical
Management of
RUQ ABDOMINAL
PAIN and
GALLBLADDER
Disorders
• What are the causes of RUQ abdominal pain?
All the tissues and organs in the RUQ area could
be the source of the RUQ abdominal pain.
• Abdominal wall
• Peritoneal lining
• Internal abdominal organs in the area (hollow
and solid organs)
• Liver
• Gallbladder
• Pancreas
• Right colon (ascending colon)
• Small intestines
• Right kidney
All kinds of medical
conditions and
diseases in these
tissues and organs
can cause abdominal
pain.
• Inflammation
• Tumors
• Stones

19. Fundamentals and
Generalities in
Medical
Management of
RUQ ABDOMINAL
PAIN and
GALLBLADDER
Disorders
• How common are RUQ abdominal pain?

20. Fundamentals and
Generalities in
Medical
Management of
RUQ ABDOMINAL
PAIN and
GALLBLADDER
Disorders
• How common are RUQ abdominal pain?
• COMMON
• No concrete data comparing
frequency of pains in other
quadrants

21. Fundamentals and
Generalities in
Medical
Management of
RUQ ABDOMINAL
PAIN and
GALLBLADDER
Disorders
• Clinical diagnosis of RUQ abdominal pain?

22. Fundamentals and
Generalities in
Medical
Management of
RUQ ABDOMINAL
PAIN and
GALLBLADDER
Disorders
All kinds of medical
conditions and
diseases in these
tissues and organs
can cause abdominal
pain.
• Inflammation
• Tumors
• Stones
• Clinical diagnosis of RUQ abdominal pain?
Processes used in clinical diagnosis of RUQ
abdominal pain:
• Pattern recognition process means realization
that the patient’s presentation conforms to a
previously learned picture or pattern of
disease.
• Prevalence process means choice of a diagnosis
is based on the frequency of occurrence of the
disease in a certain locality, in a certain age and
sex group, and in the affected organ and
system.

23. Fundamentals and
Generalities in
Medical
Management of
RUQ ABDOMINAL
PAIN and
GALLBLADDER
Disorders
All kinds of medical
conditions and
diseases in these
tissues and organs
can cause abdominal
pain.
• Inflammation
• Tumors
• Stones
• Clinical diagnosis of RUQ abdominal pain?
TIPS:
BASIC EVALUATION METHODS:
• HISTORY TAKING – TO GET SYMPTOMS
• PHYSICAL EXAMINATION – TO GET SIGNS
CLINICAL DIAGNOSIS

24. Fundamentals and
Generalities in
Medical
Management of
RUQ ABDOMINAL
PAIN and
GALLBLADDER
Disorders
All kinds of medical
conditions and
diseases in these
tissues and organs
can cause abdominal
pain.
• Inflammation
• Tumors
• Stones
• Clinical diagnosis of RUQ abdominal pain?
TIPS in evaluating / diagnosing RUQ ABDOMINAL
PAIN upon onset of pain (any unpleasant
sensation)
• Try to determine the type of pain as best as
you can.
• Feel for any associated symptoms like fever,
nausea, vomiting, diarrhea, etc.
• Recall any antecedent /precipitating events
that may lead to the pain.
• Monitor closely the pain – course and its
associated symptoms.

25. Fundamentals and
Generalities in
Medical
Management of
RUQ ABDOMINAL
PAIN and
GALLBLADDER
Disorders
• Clinical diagnosis of RUQ abdominal pain?
TIPS in evaluating / diagnosing RUQ ABDOMINAL
PAIN upon onset of pain (any unpleasant
sensation)
• Try to determine the type of pain as best as
you can.
• Feel for any associated symptoms like fever,
nausea, vomiting, diarrhea, etc.
• Recall any antecedent /precipitating events
that may lead to the pain.
• Monitor closely the pain – course and its
associated symptoms.
A simple classification
of pain that may have
diagnostic import:
Crampy / colicky pain
– hollow organ
involvement
Non-crampy / colicky
pain - may be from
any source even
hollow organ
involvement

26. Fundamentals and
Generalities in
Medical
Management of
RUQ ABDOMINAL
PAIN and
GALLBLADDER
Disorders
• Clinical diagnosis of RUQ abdominal pain?
TIPS in evaluating / diagnosing RUQ ABDOMINAL
PAIN upon onset of pain (any unpleasant
sensation)
• Try to determine the type of pain as best as
you can.
• Feel for any associated symptoms like fever,
nausea, vomiting, diarrhea, urinary
disturbance, etc.
• Recall any antecedent /precipitating events
that may lead to the pain.
• Monitor closely the pain – course and its
associated symptoms.
Associated symptoms
may give clues to the
diagnosis such as
• Fever – an
inflammation /
infection may be going
on
• Vomiting – possible
obstruction
• Diarrhea – possible
enteritis
• Urinary disturbance –
possible kidney
problem

27. Fundamentals and
Generalities in
Medical
Management of
RUQ ABDOMINAL
PAIN and
GALLBLADDER
Disorders
• Clinical diagnosis of RUQ abdominal pain?
TIPS in evaluating / diagnosing RUQ ABDOMINAL
PAIN upon onset of pain (any unpleasant
sensation)
• Try to determine the type of pain as best as
you can.
• Feel for any associated symptoms like fever,
nausea, vomiting, diarrhea, urinary
disturbance, etc.
• Recall any antecedent /precipitating events
that may lead to the pain.
• Monitor closely the pain – course and its
associated symptoms.
An antecedent /
precipitating event
may give clues to the
diagnosis such as
• History of recent
vehicular accident -
possible blunt
injury
• History of exposure
to people with
jaundice – possible
hepatitis

28. Fundamentals and
Generalities in
Medical
Management of
RUQ ABDOMINAL
PAIN and
GALLBLADDER
Disorders
• Clinical diagnosis of RUQ abdominal pain?
TIPS in evaluating / diagnosing RUQ ABDOMINAL
PAIN upon onset of pain (any unpleasant
sensation)
• Try to determine the type of pain as best as
you can.
• Feel for any associated symptoms like fever,
nausea, vomiting, diarrhea, urinary
disturbance, etc.
• Recall any antecedent /precipitating events
that may lead to the pain.
• Monitor closely the pain – course and its
associated symptoms.
After onset,
monitoring closely the
course of the
abdominal pain may
give clues to the
diagnosis such as
• Over time, the type
of pain may be
clearer in character
to enable pattern
recognition of a
medical condition
or disease.

29. Fundamentals and
Generalities in
Medical
Management of
RUQ ABDOMINAL
PAIN and
GALLBLADDER
Disorders
• Clinical diagnosis of RUQ abdominal pain?
TIPS in evaluating / diagnosing RUQ ABDOMINAL
PAIN upon onset of pain (any unpleasant
sensation)
• Try to determine the type of pain as best as
you can.
• Feel for any associated symptoms like fever,
nausea, vomiting, diarrhea, urinary
disturbance, etc.
• Recall any antecedent /precipitating events
that may lead to the pain.
• Monitor closely the pain – course and its
associated symptoms.
After onset,
monitoring closely the
course of the
abdominal pain may
give clues to the
diagnosis such as
• Over time, the
appearance of
associated
symptoms may
enable pattern
recognition of a
medical condition
or disease.

30. Fundamentals and
Generalities in
Medical
Management of
RUQ ABDOMINAL
PAIN and
GALLBLADDER
Disorders
• Clinical diagnosis of RUQ abdominal pain?
TIPS in evaluating / diagnosing RUQ ABDOMINAL
PAIN upon onset of pain (any unpleasant
sensation)
PHYSICAL EXAMINATION
LOOK AND PALPATE SIGN-based
evaluation

31. Fundamentals and
Generalities in
Medical
Management of
RUQ ABDOMINAL
PAIN and
GALLBLADDER
Disorders
• Clinical diagnosis of RUQ abdominal pain?
SIGN-based
evaluation
TIPS:
BASIC EXAMINATION OF THE ABDOMEN:
LOOK AND PALPATE
• LOOK for unusual bulge particularly in the RUQ
that may suggest mass.
• LOOK for abdominal distention that may
suggest intestinal obstruction or mass.
• PALPATE for possible presence of mass.
• PALPATE for presence of tenderness (pain on
pressure) – if present, evaluate further.

32. Fundamentals and
Generalities in
Medical
Management of
RUQ ABDOMINAL
PAIN and
GALLBLADDER
Disorders
• Clinical diagnosis of RUQ abdominal pain?
TIPS:
In looking for the SPECIFIC CAUSE of RUQ
ABDOMINAL PAIN,
use PATTERN RECOGNITION of a particular
medical condition or disease and PREVALENCE
process in those with similar presentation of
symptoms and signs.
• Primary clinical diagnosis: Most probable
• Secondary clinical diagnosis: Second most
probable
Clinical Diagnosis
General Statements:
RUQ abdominal pain
secondary to:
• Non-specific
cause
• Specific cause
(specify the
disease)

33. Fundamentals and
Generalities in
Medical
Management of
RUQ ABDOMINAL
PAIN and
GALLBLADDER
Disorders
• Clinical diagnosis of RUQ abdominal pain?
TIPS:
In looking for the SPECIFIC CAUSE of RUQ
ABDOMINAL PAIN,
use PATTERN RECOGNITION of a particular
medical condition or disease and PREVALENCE
process in those with similar presentation of
symptoms and signs.
• Primary clinical diagnosis: Most probable
• Secondary clinical diagnosis: Second most
probable
If there are cues for
a specific disorder,
such as mass or
obstruction, then
specify the disorder
and then look for
the specific cause.

34. Fundamentals and
Generalities in
Medical
Management of
RUQ ABDOMINAL
PAIN and
GALLBLADDER
Disorders
• Clinical diagnosis of RUQ abdominal pain?
TIPS:
In looking for the SPECIFIC CAUSE of RUQ
ABDOMINAL PAIN,
use PATTERN RECOGNITION of a particular
medical condition or disease and PREVALENCE
process in those with similar presentation of
symptoms and signs.
• Primary clinical diagnosis: Most probable
• Secondary clinical diagnosis: Second most
probable
If there are cues for
a specific disorder
and a specific
disease, then specify
the disorder and the
specific disease.
That will be the
diagnosis.

35. Fundamentals and
Generalities in
Medical
Management of
RUQ ABDOMINAL
PAIN and
GALLBLADDER
Disorders
• Clinical diagnosis of RUQ abdominal pain?
In patients with RUQ ABDOMINAL PAIN but
without clear-cut CUES for
• Abdominal mass
• Abdominal obstruction
and ABDOMINAL PAIN is mild and with no clear-
cut characteristics and with no CUES for a specific
disease whatsoever,
DIAGNOSIS is usually “Non-specific RUQ
abdominal pain”. [This has to be monitored
afterwards.]
Early stage of medical
condition or disease
or mild medical
condition in the
sources of pain
usually produces NO
distinct character or
nature. (Just mild
feeling of discomfort!)

36. Fundamentals and
Generalities in
Medical
Management of
RUQ ABDOMINAL
PAIN and
GALLBLADDER
Disorders
• Clinical diagnosis of RUQ abdominal pain?
In patients with RUQ ABDOMINAL PAIN but
without clear-cut CUES for
• Abdominal mass
• Abdominal obstruction
and ABDOMINAL PAIN is mild and with no clear-
cut characteristics and with no CUES for a specific
disease whatsoever,
DIAGNOSIS is usually “Non-specific RUQ
abdominal pain”. [This has to be monitored
afterwards.]
At times, watchful
waiting may allow
more distinct
character or nature of
the unpleasant feeling
to show up, thereby
facilitating diagnosis.

37. Fundamentals and
Generalities in
Medical
Management of
RUQ ABDOMINAL
PAIN and
GALLBLADDER
Disorders
• Clinical diagnosis of RUQ abdominal pain?
Onset and course of pain – aids in clinical
diagnosis
• Acute or recent - about a week or two
• Chronic – lasting for about 3 months
• Recurrent – 3 episodes within 3 months
• Progressive – increasing in intensity
Some abdominal
conditions and
diseases have typical
courses.
Some have chronic
and recurrent track
records – such as
chronic cholecystitis.
Others just one bout
or rarely recur.
Progressive connotes
serious diagnosis.

38. Fundamentals and
Generalities in
Medical
Management of
RUQ ABDOMINAL
PAIN and
GALLBLADDER
Disorders
• Clinical diagnosis of RUQ abdominal pain?
Severity of pain – aids in clinical diagnosis
• Mild
• Moderate
• Severe (of greatest urgency)
SEVERE PAIN – aside from
implying greatest urgency in
medical treatment, it also has a
connotation in diagnosis and
subsequent treatment. Example:
ACUTE ABDOMEN
Some abdominal
conditions and
diseases have typical
severity score.
Some are usually
mild. Some usually
moderate in pain.
Some usually severe.
Example: pain caused
by gallbladder stones
causing acute
obstruction will have
severe pain.

39. Fundamentals and
Generalities in
Medical
Management of
RUQ ABDOMINAL
PAIN and
GALLBLADDER
Disorders
• Clinical diagnosis of RUQ abdominal pain?
ACUTE ABDOMEN is a condition, usually with
severe abdominal pain, that demands urgent
attention and treatment.
ACUTE SURGICAL ABDOMEN is a condition,
usually with severe abdominal pain, that
demands urgent attention and operative
treatment.
ACUTE NON-SURGICAL ABDOMEN is a condition
that demands urgent attention and non-operative
treatment.
Sometimes the
specific cause of the
acute abdomen
cannot be definitely
established.
It is enough for the
physician to decide
whether it is a
SURGICAL or NON-
SURGICAL abdomen.
This is a special
category of clinical
diagnosis of
abdominal pain.

40. Fundamentals and
Generalities in
Medical
Management of
RUQ ABDOMINAL
PAIN and
GALLBLADDER
Disorders
• Paraclinical diagnostic procedures for RUQ
abdominal pain?

41. Fundamentals and
Generalities in
Medical
Management of
RUQ ABDOMINAL
PAIN and
GALLBLADDER
Disorders
• Paraclinical diagnostic procedures for RUQ
abdominal pain?
Common instrumental and laboratory diagnostic
procedures for RUQ ABDOMINAL PAIN:
• Imaging procedures (x-rays – plain / with
barium dye; ultrasound; CT scan; MRI; PET
scan; etc.)
• Endoscopy (upper - esophagogastroscopy /
lower – colonoscopy, sigmoidoscopy,
proctoscopy)
• Blood tests (CBC; liver function tests; tumor
markers; etc.)

42. Fundamentals and
Generalities in
Medical
Management of
RUQ ABDOMINAL
PAIN and
GALLBLADDER
Disorders
• Paraclinical diagnostic procedures for RUQ
abdominal pain?
The foremost indication for a paraclinical
diagnostic procedure can be stated this
way:
if you are not certain on the primary
clinical diagnosis and you need to be
certain or be more certain before
treatment, then go for a paraclinical
diagnostic procedure.

43. Fundamentals and
Generalities in
Medical
Management of
RUQ ABDOMINAL
PAIN and
GALLBLADDER
Disorders
• Paraclinical diagnostic procedures for RUQ
abdominal pain?
To decide on indication of the paraclinical
diagnostic procedure,
the physician uses two processes –
- degree of certainty on the primary
clinical diagnosis and
- comparison of the treatment plans for
the primary and secondary clinical
diagnoses.
As a rule, there is no need
for a paraclinical
diagnostic procedure if:
• you are quite
certain of your
primary clinical
diagnosis.
• treatment plans for
primary and
secondary
diagnoses are the
same.

44. Fundamentals and
Generalities in
Medical
Management of
RUQ ABDOMINAL
PAIN and
GALLBLADDER
Disorders
• Paraclinical diagnostic procedures for RUQ
abdominal pain?
Competencies required of physicians managing
RUQ abdominal pain:
• Know the uses and indications of all known
instrumental and laboratory diagnostic
procedures for abdominal pain.
• Use as needed and indicated.
• Select the most cost-effective one using the
BRCA process.
• Know how to interpret the results.

45. Fundamentals and
Generalities in
Medical
Management of
RUQ ABDOMINAL
PAIN and
GALLBLADDER
Disorders
• Paraclinical diagnostic procedures for RUQ
abdominal pain?
BRCA Process in selecting diagnostic procedures
Procedures Benefit
(goal – to
be more
definite on
the
diagnosis)
Risk Cost Availability
Option1
Option2
Option3

46. Fundamentals and
Generalities in
Medical
Management of
RUQ ABDOMINAL
PAIN and
GALLBLADDER
Disorders
• Clinical diagnosis of RUQ abdominal pain?
ACUTE ABDOMEN is a condition, usually with
severe abdominal pain, that demands urgent
attention and treatment.
ACUTE SURGICAL ABDOMEN is a condition,
usually with severe abdominal pain, that
demands urgent attention and operative
treatment.
ACUTE NON-SURGICAL ABDOMEN is a condition
that demands urgent attention and non-operative
treatment.
In patients with ACUTE SURGICAL
ABDOMEN, NO TIME should be wasted on
paraclinical diagnostic procedures just to
establish the definite cause. A surgeon
should operate without establishing the
specific cause. The operation can serve as
the paraclinical diagnostic procedure as it
will establish the cause.

47. Fundamentals and
Generalities in
Medical
Management of
RUQ ABDOMINAL
PAIN and
GALLBLADDER
Disorders
• Basic treatment modalities for RUQ abdominal
pain?

48. Fundamentals and
Generalities in
Medical
Management of
RUQ ABDOMINAL
PAIN and
GALLBLADDER
Disorders
• Basic treatment modalities for RUQ abdominal
pain?
SPECIFIC DISEASE SURGICAL / POTENTIALLY SURGICAL / NON-SURGICAL
W
X
Y
Z
• Surgical – outright surgical
• Non-surgical – non-surgical at all times (no operation)
• Potentially surgical – surgical only when needed

49. Fundamentals and
Generalities in
Medical
Management of
RUQ ABDOMINAL
PAIN and
GALLBLADDER
Disorders
• Basic treatment modalities for RUQ abdominal
pain?
• Surgical – outright surgical
• Non-surgical – non-surgical at all times (no operation)
• Potentially surgical – surgical only when needed
Examples of OUTRIGHT SURGICAL ABDOMEN
• Acute surgical abdomen
• Complete intestinal obstruction
• Peritonitis secondary to ruptured liver abscess
• Resectable tumors
Surgical Treatment:
• Drainage of
infections
(abscesses)
• Removal (-ectomy
such as
cholecystectomy)
• Repair (-rrhaphy
such as
enterorrhaphy)

50. Fundamentals and
Generalities in
Medical
Management of
RUQ ABDOMINAL
PAIN and
GALLBLADDER
Disorders
• Basic treatment modalities for RUQ abdominal
pain?
• Surgical – outright surgical
• Non-surgical – non-surgical at all times (no operation)
• Potentially surgical – surgical only when needed
Surgical Treatment:
• Drainage of
infections
(abscesses)
• Removal (-ectomy
such as
cholecystectomy)
• Repair (-rrhaphy
such as
enterorrhaphy)
Examples of POTENTIALLY SURGICAL ABDOMEN
• Asymptomatic gallbladder stones
• Asymptomatic gallbladder polyps
• Incomplete intestinal obstruction
• Asymptomatic benign tumors

51. Fundamentals and
Generalities in
Medical
Management of
RUQ ABDOMINAL
PAIN and
GALLBLADDER
Disorders
• Basic treatment modalities for RUQ abdominal
pain?
• Surgical – outright surgical
• Non-surgical – non-surgical at all times (no operation)
• Potentially surgical – surgical only when needed
Examples of OUTRIGHT NON-SURGICAL
ABDOMEN
• Viral hepatitis
• Cirrhosis
• Urinary tract infection
Non-Surgical Treatment:
• Medicines
• NO medicines (watchful waiting;
natural support management; etc.)

52. Fundamentals and
Generalities in
Medical
Management of
RUQ ABDOMINAL
PAIN and
GALLBLADDER
Disorders
• Basic treatment modalities for RUQ abdominal
pain?
BRCA Process in selecting cost-effective treatment
modality.

53. Fundamentals and
Generalities in
Medical
Management of
RUQ ABDOMINAL
PAIN and
GALLBLADDER
Disorders
• Management of GALLBLADDER DISORDERS

54. Fundamentals and
Generalities in
Medical
Management of
RUQ ABDOMINAL
PAIN and
GALLBLADDER
Disorders
• Management of GALLBLADDER DISORDERS
Gallbladder disorders are common that all
laypeople should be aware of them;
recognize them; know what to do; and be
knowledgeable of how physicians manage
them.
(A PATIENT EMPOWERMENT PROGRAM)

55. Fundamentals and
Generalities in
Medical
Management of
RUQ ABDOMINAL
PAIN and
GALLBLADDER
Disorders
• Management of GALLBLADDER DISORDERS
Gallbladder
• part of digestive system
• main function is to store bile from liver
• bile helps break down fats
• bile is a mixture of mainly cholesterol, bilirubin
and bile salts
Can one live without a gallbladder? YES

56. Fundamentals and
Generalities in
Medical
Management of
RUQ ABDOMINAL
PAIN and
GALLBLADDER
Disorders
• Management of GALLBLADDER DISORDERS
Gallbladder disorders / diseases:
• Acute cholecystitis (inflammation of
the gallbladder) usually associated with
gallbladder stones (very common)
• Gallbladder polyps
• Gallbladder cancer (rare)

57. Fundamentals and
Generalities in
Medical
Management of
RUQ ABDOMINAL
PAIN and
GALLBLADDER
Disorders
• Management of GALLBLADDER DISORDERS
In all patients with RUQ abdominal pain,
CHOLECYSTITIS WITH GALLSTONE is always a
possibility and should be considered in the
evaluation (with gallbladder stone being a
common cause of cholecystitis).
However, NOT all RUQ abdominal pains are due
to cholecystitis and gallbladder stones. Other
diagnoses should be considered such as diseases
of the liver and pancreas and other organs in the
area and also, the so-called nonspecific medical
conditions.
Among the gallbladder
disorders, reasons why
gallbladder stone with
inflammation is considered.
• Gallbladder polyps –
usually asymptomatic
• Gallbladder cancers –
usually asymptomatic –
developing symptoms
only when with big size
and advanced
• Gallstone with
cholecystitis are usually
painful.
• Gallstone without
cholecystitis –usually NO
pain.

58. Fundamentals and
Generalities in
Medical
Management of
RUQ ABDOMINAL
PAIN and
GALLBLADDER
Disorders
• Management of GALLBLADDER DISORDERS
Clinical Diagnosis of Acute Cholecystitis (usually
caused by gallstones)

59. Fundamentals and
Generalities in
Medical
Management of
RUQ ABDOMINAL
PAIN and
GALLBLADDER
Disorders
• Management of GALLBLADDER DISORDERS
Clinical Diagnosis of Acute Cholecystitis (usually
caused by gallstones)
Presence of definite, persistent, progressive pain
and tenderness on the RUQ abdomen at the area
of the GALLBLADDER

60. Fundamentals and
Generalities in
Medical
Management of
RUQ ABDOMINAL
PAIN and
GALLBLADDER
Disorders
• Management of GALLBLADDER DISORDERS
Clinical Diagnosis of Acute Cholecystitis (usually
caused by gallstones)

61. Fundamentals and
Generalities in
Medical
Management of
RUQ ABDOMINAL
PAIN and
GALLBLADDER
Disorders
• Management of GALLBLADDER DISORDERS
Clinical Diagnosis of Acute Cholecystitis (usually
caused by gallstones)
Suspect gallbladder disorder after suspecting
acute cholecystitis.
The foremost cue for the clinical diagnosis of a
gallbladder disorder is the presence of symptoms
and signs of ACUTE CHOLECYSTITIS.
Reliable sign: Presence of definite, persistent,
progressive pain and tenderness on the RUQ
abdomen at the area of the GALLBLADDER.
Gallstone as a cause
of the acute
cholecystitis is
primarily suspected
only because it is a
very common cause.
Gallbladder polyps
and cancer are usually
asymptomatic and
diagnosed only on
ultrasound and other
imaging procedures.

62. Fundamentals and
Generalities in
Medical
Management of
RUQ ABDOMINAL
PAIN and
GALLBLADDER
Disorders
Paraclinical Diagnostic Procedures for Gallbladder
Disorders
Options:
• Ultrasound
• CT scan
• MRI
Most cost-effective is ultrasound – first choice
CT scan and MRI are done only if there are
questions on ultrasound.
MRI better than CT scan in terms of info yield
• Management of GALLBLADDER DISORDERS

63. Fundamentals and
Generalities in
Medical
Management of
RUQ ABDOMINAL
PAIN and
GALLBLADDER
Disorders
Paraclinical Diagnostic Procedures for Gallbladder
Disorders
• Ultrasound
• Management of GALLBLADDER DISORDERS

64. Fundamentals and
Generalities in
Medical
Management of
RUQ ABDOMINAL
PAIN and
GALLBLADDER
Disorders
Paraclinical Diagnostic Procedures for Gallbladder
Disorders
• Ultrasound
• Management of GALLBLADDER DISORDERS
Polyps
Stones

65. Fundamentals and
Generalities in
Medical
Management of
RUQ ABDOMINAL
PAIN and
GALLBLADDER
Disorders
Paraclinical Diagnostic Procedures for Gallbladder
Disorders
• Ultrasound
• Management of GALLBLADDER DISORDERS

66. Fundamentals and
Generalities in
Medical
Management of
RUQ ABDOMINAL
PAIN and
GALLBLADDER
Disorders
Paraclinical Diagnostic Procedures for Gallbladder
Disorders
• Ultrasound
• Management of GALLBLADDER DISORDERS
GB Polyps
GB Cancer

67. Fundamentals and
Generalities in
Medical
Management of
RUQ ABDOMINAL
PAIN and
GALLBLADDER
Disorders
• Management of GALLBLADDER DISORDERS
Management of GALLBLADDER POLYPS
Polyps are usually incidental findings on
ultrasound and other imaging procedures.
They are usually asymptomatic. 95% to 99% are
NOT CANCER.
• If polyps are less than 1 cm, multiple,
pedunculated (not sessile), NO SURGERY
(cholecystectomy) is needed. Just
surveillance.
• If polyps are suspicious for cancer, SURGERY is
indicated.

68. Fundamentals and
Generalities in
Medical
Management of
RUQ ABDOMINAL
PAIN and
GALLBLADDER
Disorders
• Management of GALLBLADDER DISORDERS
Management of GALLBLADDER POLYPS
Cholesterol deposits – pseudopolyps

69. Fundamentals and
Generalities in
Medical
Management of
RUQ ABDOMINAL
PAIN and
GALLBLADDER
Disorders
• Management of GALLBLADDER DISORDERS
Management of GALLBLADDER CANCER
• If polyps are suspicious for gallbladder cancer,
SURGERY (cholecystectomy) is indicated.
• If gallbladder cancer is detected and still
operable, SURGERY is indicated. If not, just
palliative and hospice care.

70. Fundamentals and
Generalities in
Medical
Management of
RUQ ABDOMINAL
PAIN and
GALLBLADDER
Disorders
• Management of GALLBLADDER DISORDERS
Management of GALLBLADDER STONES

71. Fundamentals and
Generalities in
Medical
Management of
RUQ ABDOMINAL
PAIN and
GALLBLADDER
Disorders
• Management of GALLBLADDER DISORDERS
Management of GALLBLADDER STONES
GB stones may be asymptomatic or symptomatic.
Asymptomatic GB stones are incidental findings
on ultrasound and other imaging procedures. The
GB stones are not causing abdominal pain or
distress.
Symptomatic GB stones are those that are causing
abdominal pain and other side effects like
jaundice.

72. Fundamentals and
Generalities in
Medical
Management of
RUQ ABDOMINAL
PAIN and
GALLBLADDER
Disorders
• Management of GALLBLADDER DISORDERS
Management of GALLBLADDER STONES
For ASYMPTOMATIC GB stones, regardless of
number and size, watch and wait can be done.
After the first onset of symptoms, RUQ
abdominal pain, SURGERY (cholecystectomy –
removal of gallbladder with the contained stones)
is recommended.

73. Fundamentals and
Generalities in
Medical
Management of
RUQ ABDOMINAL
PAIN and
GALLBLADDER
Disorders
• Management of GALLBLADDER DISORDERS
Management of GALLBLADDER STONES
For SYMPTOMATIC GB stones, removal of
gallbladder with the contained stones is
recommended.
There are no more cost-effective treatment
procedures aside from SURGERY.
Medicine and the so-called “apple flushing” are
NOT effective, NOT cost-effective.

74. Fundamentals and
Generalities in
Medical
Management of
RUQ ABDOMINAL
PAIN and
GALLBLADDER
Disorders
• Management of GALLBLADDER DISORDERS
Management of GALLBLADDER STONES
In surgery for gallbladder stones, the whole
gallbladder with the contained stones are
removed. NO just the stones!
- as there will be a significant risk of recurrence
of stones if the gallbladder is left behind.
Besides, losing a gallbladder is not a risk factor
for a shortened lifespan.
- One can live without a gallbladder!

75. Fundamentals and
Generalities in
Medical
Management of
RUQ ABDOMINAL
PAIN and
GALLBLADDER
Disorders
• Management of GALLBLADDER DISORDERS
Management of GALLBLADDER STONES
In cholecystectomy or surgery for gallbladder
removal, there are currently two general
methods:
• Conventional open cholecystectomy*
• Minimally invasive cholecystectomy
*Open mini-lap cholecystectomy

76. Fundamentals and
Generalities in
Medical
Management of
RUQ ABDOMINAL
PAIN and
GALLBLADDER
Disorders
• Management of GALLBLADDER DISORDERS
Types of Cholecystectomy

77. Fundamentals and
Generalities in
Medical
Management of
RUQ ABDOMINAL
PAIN and
GALLBLADDER
Disorders
• Management of GALLBLADDER DISORDERS
Procedures Benefit Risk Cost Availability
Option1 • Very
small
incisions
• Less pain
• Early
return to
work
Higher
complication
rate
(particularly
bile duct
injury)
Most
expensive
because of
special
instruments
Some
centers –
not readily
available
Option2 Shorter
operating
time
Readily
available
Option3 Shorter
operating
time
Readily
available
Option1: Lapchole; Option2: Minilap Chole: Option 3: Longlap chole

78. Fundamentals and
Generalities in
Medical
Management of
RUQ ABDOMINAL
PAIN and
GALLBLADDER
Disorders
Summary
Take Away
Contents of RUQ ABDOMINAL PAIN
and GALLBLADDER Disorders
• What is a RUQ abdominal pain?
• What are the different types of RUQ abdominal
pain?
• What are the causes of RUQ abdominal pain?
• How common are RUQ abdominal pain?
• Clinical diagnosis of RUQ abdominal pain?
• Paraclinical diagnostic procedures for RUQ
abdominal pain?
• Basic treatment modalities for RUQ abdominal
pain?
• Management of GALLBLADDER DISORDERS

79. Fundamentals and
Generalities in
Medical
Management of
RUQ ABDOMINAL
PAIN and
GALLBLADDER
Disorders
Be always in touch with reliable medical
information on fundamentals and
generalities in medical management of
RUQ ABDOMINAL PAIN and GALLBLADDER
DISORDERS.
Take Away in
relation to
Patient
Empowerment
Knowledge is power; it gives power.
Use the 4Ks of Patient Empowerment:
Kaalaman, Kakayanan, Karapatan and
Kapangyarihan
to gain greater control over decisions in
medical management of RUQ ABDOMINAL
PAIN and GALLBLADDER DISORDERS.

80. Empowerment
objective - for
laypeople to have an
understanding of the
FUNDAMENTALS and
GENERALITIES in
MEDICAL
MANAGEMENT of
RUQ ABDOMINAL
PAIN and
GALLBLADDER
DISORDERS.
Health Disorder
Course–
Fundamentals
and
Generalities in
Medical
Management
of RUQ
ABDOMINAL
PAIN and
GALLBLADDER
Disorders
May 14, 2022
1400H - 1500H
Via Zoom
RUQ – Right Upper Quadrant