A male pt aged 45 years with past history of drinking alcojol and kindney stones., now complains of pain in the rt hypochondriac area and back.......usg normal except hepatic steatosis grade 2.....pt complai s of sever pain in ghat area . No fever Lab reports are wnl. Both direct and indirect bilirubin are on higher end (1.4 and 1.0 )respectively. KFT normal please know how to manage tgis case .@Dr. Sepuri Krishna Mohan



Causes of pain in his case would be 1. Cholecystitis 2.acute pancreatitis 3.ureteric calculi 4. Peptic ulcer disease Evaluate all above etiologies..
thanks sir

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?Gall stones blocking CBD?Renal calculus Suggest:Serum Amylase CT abdomen
Plain Ct kub Gastroenterologist opinion for liver steatosis
advise X ray KUB to look for ureteric calculi
thanks Dr Zuber

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As per management of this case more investigation needed.- Lets do usg-KUB in view of ph/o Renal calculi.- recurrence may be- Lets check Murphy's sign positive or not- symptoms suggest CHOLILTHIASIS / rt. Renal calculi-/ upper 1/3of ureter.- do LFT & RFT-
thanks sir
Serum bilirubin is with in normal limits lab reports are normal can be nephrolithiasis can be acute pancreatitis.serum amylase and lft and CECT abdomen will give proper picture . Urinalysis is also important
Causes of pain may be due to kidney stone cholesitities g fatty liver changes so give hepatic treatment for kidney stone give cystone gokshuradi guguul 2bd for pain give meftal spas or cataspa
KUB/IVP to know renal stone As bilirubin is on higher side and USG shows hepatitis steatosis, do investigate in that line and according ttment
@Dr. Zuber Ahmed Khan @Dr. Yogesh Deshpande @Dr. Prakash Shere
Pt complains severe pain .. CT abdomen and pelvis should be taken.. wt OGD scopy as emergency
thanks sir
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