Presentation on theme: "A case of upper abdo pain Joanna Wykes, FY2. You are an FY2 in general practice O A 45 year old female called Mary attends with two episodes of upper."— Presentation transcript:
You are an FY2 in general practice O A 45 year old female called Mary attends with two episodes of upper abdominal pain. She has had one episode 5 months ago and another episode yesterday. O What do you want to ask in your history?
HPC O Site: RUQ O Onset: Built up gradually O Character: squeezing O Radiation: none O Associations: Mild nausea, no vomiting O Timing: lasted about 4 hours both times O Exacerbating factors: occurred after eating fatty food both times O Severity: 6/10
PMH O Hypercholesterolaemia O Obesity O Gastric band, Dec 2013 O T2DM O Hypertension
USS O A solitary 2cm stone is found in the gallbladder. The gallbladder wall is not thickened. All other imaged organs are normal.
You phone the patient to tell her the news O It’s now 3 months since she came in to see you O She’s not had any pain since the last episode she told you about O What do you suggest?
Surgery/ watch and wait O What does the patient want? O She’s not very keen on the idea of surgery and would prefer to see how things go O Other options could be smoking cessation advice, statins or weight loss
You have moved on to your next rotation in A+E O You pick up the next patient to clerk and it’s Mary. She has upper abdominal pain again. O None of her PMH, DH, FH or SH have changed O You take a HPC
HPC O Site: RUQ O Onset: Occurred gradually O Characteristic: gripping pain O Radiations: To the back O Associations: vomited, feels hot and sticky O Timing: 4 hours now O Exacerbating factors: nil O Severity: 8/10
O In a few days time, when the inflammation has begun to settle
Everything goes very well for Mary but some patients aren’t so lucky… O What complications can occur?
Complications O Pancreatitis O Empyema O Gallstone ileus O Mucocoele O Ascending cholangitis
Summary O Gallstones are usually asymptomatic but can produce pain (biliary colic) or infection (cholecystitis) O Risk factors for gallstones include being a female, being overweight, hypercholesterolaemia and T2DM O Laparaoscopic or open cholecstectomy or ERCP can be used in management