28yr/M, k/c/o Cholelethiasis, presented with Pain Abdomen, Pain Chest, SOB. He is non DM, non Hypertensive, Serum Amylase, Lipase within Normal limits. He is having 'Jaundice'.

8 Likes

LikeAnswersShare

I think it is a case of acute cholecystitis...probably sepsis with left sided pleural effusion....though possibility of acute pancreatitis can not be ruled out in background of GB stones... Ideally IV fluids , Antibiotics and conservative management to be done with close observation...

Thanks
0

Possible DDs... Cholecystitis and Cholangitis Biliary pancreatitis Mirrizis Septic cholestasis Please send.... Cultures.... blood, urine Consider MRCP based ERCP stent Plan elective Cholecystectomy later after sepsis control.

Thank you Sir.
0

View 2 other replies

Patient has jaundice probably due to cbd stone with obstruction and cholangitis as lft and counts suggest. Mild pancreatitis may have normal amylase. Pls do mrcp and proceed with ercp and stone extraction followed by cholecystectomy

Thanks
0

Congratulations! Your case has been selected as Case of the day and you have been awarded 5 points for sharing the case. Keep posting your interesting cases, Happy Curofying!

ACUTE CALCULUS CHOLECYSTITIS PLAN :-LAP.CHOLECYSTECTOMY AFTER 15 DAYS NBM /RT CONTINUE DNS III UNIT D5% II UNIT INJ.-HEPAMERZ @6ml/Hr INJ.-LACTAGARD 1.5GM I/V BD INJ.-METROGYL100 ML I/V TDS INJ.-BUSCOPAN 1AMP.I/V TDS INJ.-PANTOCID 40MG I/V BD TAB.-CIBOZ 550MG BD TAB.-URSOCOL 300mg BD SYP.-SORBILLIN 2TSF TDS SYP.-LACTOLOSE 20ml HS

I think the first thing u should do is to do MRCP to see the biliary plus pancreatic anatomy and presence of any CBD stone....or other reasons which may explain the cause for obstructive jaundice... Further proceedings like ERCP etc will be guided thereafter...

Obstructive jaundice Needs ERCP Plan Cholecystectomy

Thanks
1

symptomatic cholelithiasis ; need cholecystectomy; left pleural effusion due to pancreatitis

Thanks, but his sr Amylase and Lipase are not elevated.
0

Thanks to All Esteemed colleague offering their valuable opinion. The patient has responded well to conservative management of IVF, Antibiotics. He is being prepared for Elective Cholecystectomy. MRCP was done, was non contributory.

conjugated hyperbilirubinaemia with high ALP signifies cholestasis ,as SGPT level is not much altered ,probably it is a case of extra hepatic cholestasis , consolidation noted in left lower lobe, urine shows few pus cell with RBC , urine c/s and xray KUB will be helpfull

Thanks Sir.
0
Load more answers

Cases that would interest you