A 35 year old female comes to your OPD with complaints of vomiting, fever & rigors, and severe pain in her right hypochondrium.
Saad Gillani
CONSULTANT PHYSICIAN ( ACUTE & INTERNAL MEDICINE ) FRCP GLASGOW at ROYAL COLLEGE OF PHYSICIANS AND SURGEONS OF GLASGOW
A 35 year old female comes to your OPD with complaints of vomiting, fever & rigors, and severe pain in her right hypochondrium.
Her Temperature is 37.5 C and you find out there is tenderness in the Right Hypochondrium on inspiration. ( Positive Murphy's sign)
Her ultrasound is shown below:
1.What are the findings in the ultrasound ?
2. What is the most likely diagnosis?
3. How will you manage this condition?
Answers given in comments section.
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Anonymized Data , consent taken for teaching purposes,
1.What are the findings in the ultrasound ?
A. Distended Gall bladder.
B. Multiple gallstones ( 3-4 mm) Almost 5 in number.
C. Presence of sludge in gall bladder.
2. What is the most likely diagnosis?
Most likely diagnosis is Acute Cholecystitis with Cholelithiasis.
The clinical history with positive Murphy's sign is pathognomonic of Acute Cholecystitis.
And the ultrasound shows Multiple gall stones which is the main cause of Acute Cholecystitis in this case.
3. How will you manage this condition?
Management involves keeping patient NBM ( Nil by mouth ), intravenous fluids, intravenous broad spectrum antibiotics including Metronidazole and Cephalosporins , intravenous opioid analgesics with antiemetics and anti spasmodics.
Once Acute phase is treated, Cholecystectomy should be considered after excluding any contraindications.