Past health history- obesity, multiparty, infection, cancer, extensive fasting, pregnancy.
Medications- estrogen or oral controceptives
Surgery- abdominal surgery
Weight loss, anorexia; indigestion, fat intolerance, nausea and vomiting, dyspepsia; chills. Clay-colored stools, steatorrhea, flatulence; dark urine, moderate to severe pain in RUQ that may radiate to back or scapula; pruritus. Fever, restlessness, jaundice, icteric sclera, diaphoresis, tachypnea, splinting during respirations, tachycardia, palpable gallbladder, abdominal gaurding/distention
Diagnostics: History and physical examination, ultrasound, endoscopic retrograde cholangiopancreatography (ERCP), Percutaneous transhepatic cholangiography, liver function studies, WBC, serum bilirubin
Management: IV fluid, NPO with NG tube, procession to low-fat diet, antiemetics, analgesics, Fat-soluble vitamins (A,D,E,K), Anticholinergics (antispasmodics), antibiotics (for secondary infection), transhepatic biliary catheter, ERCP with sphincterotomy (papillotomy), Extracorporeal shock wave lithrotripsy.
Surgical therapy: laproscopic cholecystectomy, incisional cholecystectomy
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