QUIZ: Eligible for surgery?

Wednesday, 18 May 2011 17:46

Case description: 27-years old female came to gastroenterologist's office because of a pain in right hypochondrium. She notifies, that since about 1,5 month she feels a middle-intensity pain in this localization, and she feels an unpleasant taste in her mouth. The patient came to well-equipped clinic, in which there is an USG. Physician, during that examination, found out cholecystoliths.

QUIZ questions:

Does patient qualify to a cholecystectomy?

About what additional symptoms should we ask?

Are there any other tests necessary?

Comments

0 #1 katia 2011-05-18 19:33

does she have any hemolytic anemia?

0 #2 eleonora 2011-05-18 19:38

Any fever? jaundice? nausea? vomiting? Does she have a family history of cholelithiasis? Does she suffer from haemolytic anaemia? Any drugs? The unusual taste in her mouth when did it start? with the pain? and is it constant or has to do with certain food?
FBC, Reticulocytes, AST,ALT,ALP, GGT, bilirubin direct and indirect,LDH. That for a start.

0 #3 Mateusz Palczewski 2011-05-18 21:21

She doesn't have a faver, jaundice, nausea, she is not vommiting. Patient doesn't remember about cholelihtiasis in family history.

My next questions:
1. Do you go for tests or you rather make some physical examination before?
2. What would give you if she has or not hemolytic anemia?

0 #4 eleonora 2011-05-18 21:43

You're right PE first! Blame it on the momentum! To check for haemolytic anaemia I would order Ht, Hb, Reticulocytes, LDH, Coombs.

0 #5 eleonora 2011-05-18 22:06

and indirect bilirubin

0 #6 Mateusz Palczewski 2011-05-19 15:42

Lab test which you performed are within normal.
What would you expect in PE? Do you perform any other diagnostic?

0 #7 eleonora 2011-05-19 17:27

I would check for Murphy's sign, sensitivity in the abdomen. What's her U&E like?Is Giordano's sign positive?

0 #8 Mateusz Palczewski 2011-05-21 17:45

Murphy's sign negative, slight sensitivity in abdomen, Giordano's sign negative, U&E within normal.

What do you do with patient? What other diseases could cause this kind of symptoms?

0 #9 katia 2011-05-21 19:13

could you describe about her unpleasant taste e.g metalic taste,bitter taste and so on?

0 #10 eleonora 2011-05-22 21:44

It could be something metabolic. Any changes in weight? Skin changes? Exposure to drugs or toxic agents?

0 #11 Mateusz Palczewski 2011-05-22 22:17

Eleonora, you go to deep. Think about more frequent causes of pain in this region.

0 #12 Mateusz Palczewski 2011-05-22 22:18

katia, she says that it's hard to describe her taste.

0 #13 eleonora 2011-05-22 22:40

an CXR to see the base of the lungs?

0 #14 eleonora 2011-05-22 22:40

the right base

0 #15 katia 2011-05-23 20:30

does she have any history of acute pancreatitis(fo r rule out of pancreatic pseudocyst)?

0 #16 eleonora 2011-05-26 21:57

Does she have any history of peptic ulcer?Is she taking NSAIDs? Did she have her appendix removed?

0 #17 mhamouda 2011-07-19 13:10

What about Crohn's Disease ..She's about the right age.She's got oral manifestations ( change in taste ) . Did she experience any changes in her bowel lately . ??

0 #18 mhamouda 2011-07-19 13:14

And also affecting the ileum it interrupts the enetrohepatic circulation..hence the gall stones . I would order ?Initial investigations are full blood count, C reactive protein, liver function tests, stool culture and microscopy.