🌀 من الحالات الشائعة لألم البطن هي المرارة بسبب الاكل الدهني
Risk factors 6 Fs:
Fat, Female, Fertile, Forty,
Fair-skinned, Family history.
عادة يكون المريض middle age عنده
RUQ pain commonly follow a heavy meal (may radiating to the epigastrium, back, or shoulders) + N/V last few hrs with or without fever + previous similar attack.
*If pain persist longer consider acute cholycystitis or cholangitis
On exam :
-جيك الفايتلز
-Pt with biliary colic typically have mild RUQ tenderness
-In acute cholecystitis, tenderness is more severe
+murphy sign ( sudden cessation of deep inspiration due to pain when examining fingers reach the inflamed gallbladder upon palpation of the right subcostal region)
تحط ايدك تحت الcostal margin عل الجانب اليمين وتضغط وتسأل المريض ياخذ نفس ..حيصير عنده الم ويوقف النفس
It’s 65% sensitive and 87% specific for acute cholecystitis.
-Presence of jaundice indicate obstruction of CBD from choledocholithiasis or extrinsic compression of the bile duct by an impacted cystic duct or gallbladder stone or adjacent inflammation (Mirizzi’s syndrome).
Invx :
ECG, CBC , CRP , LFT , GUE , US
DDx :
MI, leaking aortic aneurysm, peptic ulcer, intestinal obstruction or ischaemia, pancreatitis, renal colic, and pneumonia.
TRx :
-canulla + NPO
-paracetamol vial IV 1g or ketorolac 30mg IV
-plasil amp 10mg IV or IM
-N/S 500 cc
-ceftrixone vial IV 1g + flagyl 500 mg IV
if suspected cholecystitis
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Risk factors 6 Fs:
Fat, Female, Fertile, Forty,
Fair-skinned, Family history.
عادة يكون المريض middle age عنده
RUQ pain commonly follow a heavy meal (may radiating to the epigastrium, back, or shoulders) + N/V last few hrs with or without fever + previous similar attack.
*If pain persist longer consider acute cholycystitis or cholangitis
On exam :
-جيك الفايتلز
-Pt with biliary colic typically have mild RUQ tenderness
-In acute cholecystitis, tenderness is more severe
+murphy sign ( sudden cessation of deep inspiration due to pain when examining fingers reach the inflamed gallbladder upon palpation of the right subcostal region)
تحط ايدك تحت الcostal margin عل الجانب اليمين وتضغط وتسأل المريض ياخذ نفس ..حيصير عنده الم ويوقف النفس
It’s 65% sensitive and 87% specific for acute cholecystitis.
-Presence of jaundice indicate obstruction of CBD from choledocholithiasis or extrinsic compression of the bile duct by an impacted cystic duct or gallbladder stone or adjacent inflammation (Mirizzi’s syndrome).
Invx :
ECG, CBC , CRP , LFT , GUE , US
DDx :
MI, leaking aortic aneurysm, peptic ulcer, intestinal obstruction or ischaemia, pancreatitis, renal colic, and pneumonia.
TRx :
-canulla + NPO
-paracetamol vial IV 1g or ketorolac 30mg IV
-plasil amp 10mg IV or IM
-N/S 500 cc
-ceftrixone vial IV 1g + flagyl 500 mg IV
if suspected cholecystitis
〰〰〰〰〰〰〰〰〰〰