46 yo woman - middle aged, mild immune system response, reproductive age

ruq abdominal pain - ex : hepatitis, congested hepatomegaly, right lobe pneumonia

organs - liver, gallbladder, duodenum, head of pancreas, right kidney

er - need immediate treatment, acute pain,

HX - HOPI (SOCRATES)

• site- right upper quadrant, specific loc- hypochondriac, lumbar,periumbilical,epigastric

• onset-sudden or gradual, how many times did the pain occured

• characteristics- sharp, burning, colicky, dull, cramping

• radiation- radiate to the back

• assc symptoms- relieving factors- rest, med, position, food

• time- how long, duration, reccurent episodes

• exacerbating factors- relieving factors- rest, med, position, food

• 
  

resp system

• pneumonia - pleuritic chest pain, sharp pain (SOB, chest pain, contact w another person w the same symptoms)

• pneumothorax- pleuritic chest pain, sharp pain (blunt trauma)

  2. GIT

     • AAA- central abdominal pain, if pain radiated- radiation of the pain from central (any central radiate to back pain, hypertension, DM)

     • cholelithiasis - acute (COLICKY PAIN, aggravted by spicy fatty meals)

     • cholecystitis (same as above)

     • cholangitis (jaundice)

     • cholangiocarcinoma (jaundice, loss of weight, loss of appetite)

     • acute pancreatitis (pain radiate to back, fever)

     • gastritis (central pain of epigastric region, food intake, nausea, vomiting, spicy food intake)

     • peptic ulcer (same as above)

     • gastroenteritis (diarrhea, vomiting, food intake)

     • appendicitis - atypical loc of appendix (umbilical pain, RIF pain)

     • hepatitis (A- jaundice, fever, diarrhea hepatomegally, B&C - jaundice)

     • liver abscess (fever, jaundice)

       3. GU

     • right kidney stone (colicky, ask for UTI symptoms, hematuria)

     • pylonephritis (infection, UTI symptoms, fever)

       
       

       4.reproductive

     • ovarian torsion (towards lower part)

     • ectopic pregnancy (miss period)

       5. CVS

          • MI ( in dextrocardia) (chest pain, sharp pain, SOB, sweating, pain radiated to jaw and right arm)

          • aortic dissection (pain radiate to mid scapula region)

Gestational diabetes - type of diabetes develop during pregnancy, second and third trimester, resolved after pregnancies

intermittent dull pain -steady or persistent pain that is low to moderate in intensity, can indicate gall bladder issue

diaphoresis - excessive sweating

oral contraceptive -m hormonal med to prevent pregnancies, stop ovulation period

the pain started about 12 hours earlier in the upper abdomen after a fatty

resp system

• pneumonia - pleuritic chest pain, sharp pain (SOB, chest pain, contact w another person w the same symptoms)

• pneumothorax- pleuritic chest pain, sharp pain (blunt trauma)

  2. GIT

     • AAA- central abdominal pain, if pain radiated- radiation of the pain from central (any central radiate to back pain, hypertension, DM)

     • cholelithiasis - acute (COLICKY PAIN, aggravted by spicy fatty meals)

     • cholecystitis (same as above)

     • cholangitis (jaundice)

     • cholangiocarcinoma (jaundice, loss of weight, loss of appetite)

     • acute pancreatitis (pain radiate to back, fever)

     • gastritis (central pain of epigastric region, food intake, nausea, vomiting, spicy food intake)

     • peptic ulcer (same as above)

     • gastroenteritis (diarrhea, vomiting, food intake)

     • appendicitis - atypical loc of appendix (umbilical pain, RIF pain)

     • hepatitis (A- jaundice, fever, diarrhea hepatomegally, B&C - jaundice)

     • liver abscess (fever, jaundice)

       3. GU

     • right kidney stone (colicky, ask for UTI symptoms, hematuria)

     • pylonephritis (infection, UTI symptoms, fever)

       
       

       4.reproductive

     • ovarian torsion (towards lower part)

     • ectopic pregnancy (miss period)

       5. CVS

          • MI ( in dextrocardia) (chest pain, sharp pain, SOB, sweating, pain radiated to jaw and right arm)

          • aortic dissection (pain radiate to mid scapula region)

Obese class 2 BMI: 37.2

temp: high - fever

heart rate: normal

RR: normal

BP: normal

murphy's sign positive: present of acute cholecystitis - key for gallbladder inflammation

wbc - high (bacteria infection)

crp - high (bacteria)

esr - high (inflammation / infection)

renal function test - preparation for surgery, look for dehydration / not

liver function test - indicate jaundice, affect at biliary tract or not, high : obstruction at biliary tract if high bilirubin proceed to ercp

1.7-cm gallstone impacted in the neck of the gallbladder, with a

distended gall bladder and thickening (6.8 mm) of the gall

bladder wall - big enough

acute calculous cholecystitis - gallbladder stone

hospitalised and started antibiotics (a cephalosporin, e.g. cefuroxime) - normal gi organism (e. coli, klebsiella, enterococcus, anaerobes organism), analgesics, nil by mouth and IV fluids to stabilise her condition

performed laparoscopic cholecystectomy on the day 2 and was discharged in stable condition

recommended to maintain a healthy weight, combine a balanced high calcium high fibre diet with daily exercise