1. Case Report
History
A 44-year-old housewife presented to the emergency department with 1-day history of upper abdominal pain and vomiting. The pain came on suddenly, shortly after eating her evening meals.

2. Case Report
Examination The patient is febrile with a temperature of 99°F and a pulse rate of 116/min. She has tenderness in the RUQ, worsened by placing two fingers beneath the tip of the ninth costal cartilage during inspiration What is the most likely diagnosis? What is the differential diagnosis?

3. Cholelithiasis Faisal Ghani Siddiqui Head, Surgical Unit-I
MBBS; FCPS (GENERAL SURGERY); PG DIPLOMA-BIOMEDICAL ETHICS; MCPS-HPE; FICLS; (MHPE)
Head, Surgical Unit-I
Professor of Surgery
Chairman, Department of Surgery &
Director, Department of Medical Education
LIAQUAT UNIVERSITY OF MEDICAL & HEALTH SCIENCES

4. Cholelithiasis -Objectives
By the end of this presentation the final year MBBS students will be able to:
Interpret findings in patients with cholelithiasis
Design management plan for the treatment of patients with gallstones

5. Cholelithiasis
Diagnosis

6. Diagnosing Cholelithiasis
History
Physical examination
Ultrasound abdomen

7. Cholelithiasis –History
Asymptomatic; incidentally diagnosed
Pain associated with flatulent dyspepsia
Dull, constant pain
Biliary colic
Complications

8. Cholelithiasis - Complications
Acute cholecystitis
Mucocoele
Empyema
Perforation and peritonitis
Biliary obstruction
Obstructive jaundice
Acute cholangitis
Acute pancreatitis
Intestinal obstruction (gallstone ileus)

9. Cholelithiasis –Physical Findings
Jaundice
RUQ Tenderness
Murphy’s sign
Mass

10. Cholelithiasis -Ultrasonography

11. Cholelithiasis
Treatment

12. Cholelithiasis -Treatment
asymptomatic, incidentally diagnosed gallstones
Do nothing!

13. Cholelithiasis -Treatment
Symptomatic gallstones
If complications develop
cholecystectomy!

14. Cholelithiasis – General Principals of Treatment
‘Wait and watch’
Asymptomatic
Cholecystectomy
Symptomatic gallstones
If complications develop

15. Cholecystectomy
Open
Laparoscopic

16. Cholelithiasis –Management of Acute Cholecystitis
NPO
I.V. fluids
Analgesics
Antibiotics
Cholecystectomy
Emergent
Elective

17. Cholelithiasis –Management of Empyema of Gallbladder
Cholecystostomy, followed by
Cholecystectomy

18. Case Report
History
A 44-year-old housewife presented to the emergency department with 1-day history of upper abdominal pain and vomiting. The pain came on suddenly, shortly after eating her evening meals.

19. Case Report
Examination The patient is febrile with a temperature of 99°F and a pulse rate of 116/min. She is found to have tenderness in the RUQ, worsened by placing two fingers beneath the tip of the ninth costal cartilage during inspiration What is the most likely diagnosis?

20. Probable diagnosis
Acute Cholecystitis

21. Differential Diagnosis
Acute Appendicitis
Perforated peptic ulcer
Acute pancreatitis
Acute pyelonephritis MI
Right basal pneumonia