Gallstone disease

Calculated

Step 1: View clinicals

A 48 year old lady presents with intermittent upper abdominal pain for 6 months. The pain is dull, radiates towards her back and is often precipitated by heavy meals. There is no history of fever or jaundice. Three months prior to the onset of pain, she had begun to experience vague upper abdominal discomfort, intermittent heartburn and indigestion. Her medical history is unremarkable. She does not smoke, only consumes alcohol intermittently, and is nulliparous.


Step 2: Order all relevant investigations

ECG

Serial ECGs are obtained; all appear normal.

Ultrasound Abdomen

Multiple small calculi are noted in the gallbladder fundus. The gallbladder is of normal volume and the walls are not thickened. No calculi are visualized in the biliary tree, and biliary tract is not dilated. The liver, pancreas, spleen and kidneys appear normal.

Upper GI Endoscopy

The stomach, duodenum and esophagus appear normal upon endoscopy.

Amylase + Lipase

S. Amylase : 103 U/l (range: 23 - 85) S. Lipase : 45 U/l (range: 7 - 60)


Step 3: Select appropriate management

Pancreatin stat
Antibiotics stat
Shockwave Lithotripsy
Lap. Cholecystectomy


Score: ★★☆