A young male with recurrent SAIO

A male aged 23 years Chief Complaints Colicky Pain Abdomen (on/off) Bilious Vomiting Obstipation (x 2 months) Physical Examination At presentation, Examination normal Investigations CECT W/A

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CBC ESR Endoscopic exam. Rule.out KOCH'S and Is any history of abdo. surgery Try to reach at final diagnosis Then TT will.be of good result

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Bile and digestive enzymes are carried by the bile ducts from the liver, gallbladder, and pancreas to the small intestine. The bile carries away wastes from the liver and helps digest fats. A portion of the bile is stored in the gallbladder. Eating a meal makes the gallbladder contract, or squeeze inward. This empties the gallbladder’s contents into the small intestine. Symptoms A person with biliary colic typically feels pain in the middle to right upper abdomen. The pain can feel sharp, crampy, or like a constant dull ache. Colic often occurs in the evening, especially after eating a heavy meal. Some people feel it after bedtime. The worst pain of biliary colic commonly lasts for 30 minutes to an hour, but may continue at a lower intensity for several more hours. The pain stops when the gallstone breaks free of the bile duct and passes into the intestine. Nature of vomit and relation to meals - partially digested food and delay in vomiting after eating may indicate gastric outlet obstruction or gastroparesis. Bilious vomiting suggests small bowel obstruction and faeculent vomiting suggests colo-intestinal fistulae. obstipation is when a person cannot pass stool or gas, usually due to an obstruction or blockage of hard, difficult-to-pass stool. Treatment The usual treatment for gallstones is surgery to remove the gallbladder. This is known as a cholecystectomy. Laparoscopic surgery, or keyhole surgery, is the most common way to perform a cholecystectomy Many people with gallstones don’t experience biliary colic. In such cases, the underlying gallbladder problem is silent, meaning it does not cause noticeable problems. Chronic gallstones can be cured with surgery. gallbladder isn’t essential to your digestive health, so it can be removed. Once the gallbladder is removed, bile flows directly from the liver to the intestine, and causes no health problems. stool softeners, such as docusate sodium (Colace) enemas, which involve instilling water mixed with other compounds, such as soap or glycerin increased fluid intake If these steps do not relieve obstipation, a doctor may manually remove stool that is impacted near the rectal opening. throwing up bile depends on what’s causing it. If you have food poisoning or you’ve been binge drinking, you may need to get intravenous fluids and electrolytes in the hospital. If you have bile reflux, you might start by prescribing one of these medications: Ursodeoxycholic acid. This drug changes the composition of bile to help it flow more easily through your body. It can cause side effects like diarrhea. Bile acid sequestrants. These drugs disrupt the circulation of bile. They can cause side effects like bloating. If medications don’t control the problem, the next step might be surgery. Surgical options for treating bile reflux include Roux-en-Y gastric bypass. This procedure is also used to treat obesity. It creates a new connection to the small intestine to keep bile from draining into the stomach. There are also surgical treatments for adhesions or a blockage in your bowel. You will remove the cause of the obstruction. They may also remove a piece of your intestine if it’s damaged. Another option is to place a wire mesh tube called a stent inside your intestine to keep the area open and relieve the blockage.

Case of saio Definitely mass seen in lt liver Triphasic liver ct Core biopsy HP Opinion of gastroenterologist Sos enteroscope

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Obstructive GB calculus seen at neck of GB Some hypoechoic shadows are also seen in rt lobe needs to workout

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Acalculus, cholecystitis

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