Orris
attachment
attachment

Interpret and suggest treatment ! The patient has abdominal pain

analyse_media
Reading File
Reading File
Reading File
Finding Sources
Finding Sources
Searching PubMed

cholelithiasis AND cholecystectomy

Searching the Web

NICE gallstone disease symptomatic gallstones elective laparoscopic cholecystectomy guideline

Reading File
Reading File
Finding Sources
The ultrasound shows multiple gallbladder stones (cholelithiasis), about 5-7 mm each. The bile duct (CBD) is clear and not dilated.
Reassuring findings: there is no ultrasound evidence of acute gallbladder infection/inflammation at present:
  • Gallbladder wall is thin
  • No fluid around the gallbladder
  • Sonographic Murphy sign is negative
  • No bile-duct stone or obstruction is seen
  • Liver, pancreas, kidneys, uterus and ovaries are otherwise unremarkable

Likely interpretation

If her pain is in the right upper abdomen or upper central abdomen, particularly episodic pain after fatty meals, sometimes radiating to the right shoulder/back, this is likely symptomatic gallstones (biliary colic).
The report also notes minimal fluid in the pouch of Douglas (POD). In a reproductive-age woman this can be physiologic, for example around ovulation, but should be interpreted alongside menstrual history, pelvic symptoms, and a pregnancy test if pregnancy is possible. It does not explain typical right-upper-abdominal biliary pain by itself.

Recommended next steps

  1. Clinical review today or soon, ideally with a general surgeon or gastroenterologist, if the pain pattern is compatible with biliary colic.
  2. Obtain blood tests, especially if pain is significant or recurrent:
    • CBC
    • Liver tests: bilirubin, AST/ALT, ALP/GGT
    • Serum lipase/amylase
    • Urine test and pregnancy test if relevant.
  3. If symptoms are confirmed to be from gallstones, the definitive treatment is planned laparoscopic cholecystectomy (keyhole gallbladder removal). Guidelines recommend this for symptomatic gallbladder stones, whereas silent stones generally do not need treatment. NICE guidance
    Fischer's Mastery of Surgery - 8th e, p. 4526 states that symptomatic cholelithiasis/biliary colic is the commonest indication for cholecystectomy.
  4. Until reviewed:
    • Avoid foods that reliably trigger attacks, particularly fatty or fried meals.
    • Eat smaller, lower-fat meals and keep hydrated.
    • Use only clinician- or pharmacist-approved pain relief, considering allergies, ulcer/kidney disease, pregnancy, and other medicines.
    • Do not start antibiotics solely based on this scan. There is no current ultrasound evidence of acute cholecystitis; antibiotics are reserved for suspected infection and need clinician selection.

Seek emergency care now if any of these occur

  • Severe or constant abdominal pain lasting more than 4-6 hours
  • Fever, chills, repeated vomiting, fainting, or inability to drink fluids
  • Yellow eyes/skin, dark urine, or pale stools
  • New severe upper-abdominal pain radiating through to the back
  • Pregnancy possibility with pelvic pain, vaginal bleeding, dizziness, or shoulder-tip pain
For symptomatic stones, surgery is typically the durable solution rather than repeated pain treatment. Bailey and Love's Short Practice of Surgery, 28th Edition, p. 1266 describes cholecystectomy as the treatment of choice when symptomatic gallstones are present and there is no contraindication.
This is a shared conversation. Sign in to Orris to start your own chat.