1. Mark Anthony Melitante Leviste Ateneo School of Medicine and Public Health Batch 2013

2.   JP  32 years old  Male  Roman Catholic  Filipino General Data

3.  Gallstones on Ultrasound Chief Complaint

4.  History of Present Illness 1 year PTC Patient was found to have a 0.3 cm polyp in Gallbladder via routine pre-employment ultrasound No medications given and procedures done Patient did not feel any pain

5.  History of Present Illness 1 year PTC Patient was advised to engage more in exercise and to change his diet.

6.  History of Present Illness 1 mo. PTC Polyps were seen on routine pre-employment physical examination. The polyps increased to 0.6 cm in size. This prompted patient to seek second opinion.

7.  History of Present Illness 1 mo. PTC Repeat ultrasound revealed gallbladder stones, measuring about 0.6 cm each. Thus prompting admission for procedure.

8.   Unremarkable  Pertinent negatives  General symptoms: fever, weight changes, headache, dizziness  Skin: Rashes, changes in skin color (jaundice)  GI symptoms: nausea, vomiting, changes in bowel movements  GU symptoms: changes in urine color Review of Systems

9.   Unremarkable  No history of other gastrointestinal diseases  No history of previous surgeries and hospitalization  No known allergies Past Medical History

10.  Family and Personal-Social History  Asthma – siblings  No known first and second degree relatives having the same symptoms  College Graduate (BS MT)  Occupation: Seafarer  Smoker, 11.25 pack- year  Occasional drinker  No history of illicit drug use  Diet include rice with pork, fish and veggies

11.   Anthropometrics  Height: 175.5 cm  Weight: 91 kg.  BMI: 29.54 kg/m2  Vital Signs  BP: 100/80 mmHg  HR: 90 beats/min., regular rate  RR: 24 breaths/min., regular rate  Temp: 36.2 degrees Celsius  Patient is coherent, alert, not in pain and respiratory distress Physical Examination

12.   Unremarkable  Pertinent Negatives  HEENT: anicteric sclera  CP: normal chest expansion, clear BS, normal rate and rhythm, no wheezes, rales; PMI located at 5 th ICS,LML, regular rate and rhythm, good S1 and S2, no heaves, thrills or lifts Physical Examination

13.   Pertinent Negatives  Abdomen: protuberant, without visible pulsations and lesions, normoactive bowel sounds, no tenderness, organomegaly, negative Murphy’s sign, direct and rebound tenderness  Neurologic: Intact Physical Examination

14.  Salient Features SUBJECTIVE  32/M  Gallstones on ultrasound  Diet include more on protein-rich food  Seafarer OBJECTIVE  Normal PE findings  Overweight based on BMI

15.  Cholelithiasis Assessment

16.   Gallbladder stones  Formed due to abnormality in bile salt constituents  Two types:  Cholesterol  Pigment  Most are asymptomatic  Most common cause  Increased biliary secretion of cholesterol Cholelithiasis

17.   Risk Factors:  High fat diet  Obesity  First degree relative who have cholelithiasis  Pregnancy  Prolonged parenteral nutrition  Race  Female sex hormones Cholelithiasis

18.   Signs and Symptoms  Most are asymptomatic  Right upper quadrant pain, with radiation to interscapular area or shoulder  Jaundice  Fever Cholelithiasis

19.   Differential Diagnoses  Gallbladder polyps  Peptic ulcer disease  Gastroesophageal Reflux (GER)  Irritable bowel syndrome  Hepatitis Cholelithiasis

20.   Imaging Modalities  Abdominal/RUQ Ultrasound  Endoscopic retrograde Cholangiopancreatography  Abdominal CT Scan  Laboratory Studies  Bilirubin levels  Liver function tests Cholelithiasis

21.   Treatment  Surgery: Cholecystectomy  Open  Laparoscopic  Gallstone Dissolution  Ursodeoxycholic acid Cholelithiasis

22.   Possible complications  Cholecystitis  Pancreatitis  Cholangitis  Chronic cholelithiasis Cholelithiasis

23.  Elective surgery via Laparoscopic Cholecystectomy Plan

24. Admission Conference May 24, 2011 St. Martin de Porres Charity Hospital