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

(Edited)

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

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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
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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

?Gall stones blocking CBD?Renal calculus Suggest:Serum Amylase CT abdomen

Take USG & xray for kub calculi as well as endospy for deudenum.

thanks sir
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USG whole abdomen X ray KUB needs to be done for further management.

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Pt complains severe pain .. CT abdomen and pelvis should be taken.. wt OGD scopy as emergency

thanks sir
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advise X ray KUB to look for ureteric calculi

thanks Dr Zuber
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Plain Ct kub Gastroenterologist opinion for liver steatosis

Check amylase and lipase. Endoscopy. Plan ct abdomen.

thanks sir ...will follow up
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