Case (45)

[dr-awale]

50-year old woman presents to the keysaney emergency room with a 24-hour history of abdominal
pain that began approximately one hour after a reportedly large dinner. The pain began as a
dull ache in the epigastrium but then localized in the right upper quadrant. She reports some
nausea but no vomiting. Since her arrival to the ER, the pain has decreased significantly.
She admits to a number of previous episodes in the recent past. Her medical history is
significant for type II diabetes mellitus. On physical examination, her temperature is 38.1 C
(99 F). Remaining vital signs are normal. The abdomen is nondistended with minimal
tenderness in the RUQ. The liver, rectal and pelvic examinations are normal. CBC reveals
a WBC count of 13,000/mm. Serum chemistry studies demonstrate total bilirubin 1.8
mg/dL, direct bilirubin 0.6 mg/dL, alkaline phosphatase 140 U/L, AST 45 U/L and ALT 30
U/L. Ultrasonography of the RUQ demonstrates stones in the gallbladder, a thickened
gallbladder wall, and a common bile duct diameter of 4.0 mm.
1.What is the most likely diagnosis?
2. What is the best therapy?
3. What are the complications associated with the disease process?

[Dr.Shariif]

cholecystitis
therapy:
For most patients, in most centres, the definitive treatment is surgical removal of the gallbladder. Supportive measures are instituted in the meantime and to prepare the patient for surgery
complications:
Perforation or rupture
Ascending cholangitis
Rokitansky-Aschoff sinuses

[dr-awale]

asc thank u for u're zuhdak, u get 15 mark
thank u allah yubarik