CaseStudy_21112016 - Colicky RUQ pain

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21 Nov 2016 - General

An middle aged lady, with background of hypertension, type 2 diabetes mellitus, previous cholecystectomy 5 years ago, smoker 30 pack years, and increased body mass index, was admitted to hospital due to 2 days history of colicky type right upper quadrant pain, associated with intermittent fever and rigor. She was well prior to that. There was no chest pain, no shortness of breath, no productive cough, no urinary symptoms, no calf pain and no calf swelling. On examination, her temperature was high at around 38 celciusm with scleral icterus and some discomfort over the right upper quadrant. Blood tests showed elevated white cell count, elevetaed neutophil, high inflammatory marker (CRP), and cholestatic pattern of deranged liver function test. What is your working diagnosis for this patient ?? What are the investigations and managment plan for her ?

Yes, liver function test was done, which showed cholestatic pattern of deranged liver function test, in which Bilirubin , ALP, and GGT were elevated. The likely working diagnosis for this patient will be biliary stone leads to cholangitis. She should be given antibiotic immediately. A MRCP (Magnetic resonance cholangiopancreatography) should be done to confirm the presence of stone in the common bile duct. Sometime, ultrasound abdomen can be done first prior to the MRCP, which can also provide u...
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