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(BQ) Continued part 1, part 2 of the document Emergency medicine and critical care with 100 common cases has contents: Upper abdominal pain, gripping abdominal pain and vomiting, severe epigastric pain, acute severe leg pain, testicular pain after playing football, and other contents. Invite you to refer. | Emergency medicine and critical care with 100 common cases: Part 2 GENERAL SURGERY AND UROLOGY CASE 57: UPPER ABDOMINAL PAIN History A 43-year-old overweight male presents with an 8-hour history of worsening upper abdomi- nal pain that radiates to his back. He has vomited twice. He denies any bowel or urinary symptoms. This is the first time the pain has lasted this long; usually it resolves within 2 hours. His comorbidities include diabetes milletus and hypertension. He smokes 30 cigarettes per day and 40 units of alcohol per week. Examination Vital signs: temperature of 38.7°C, heart rate of 108, blood pressure of 154/78, respiratory rate of 22, 96% saturation on room air. He has guarding in the right upper quadrant, but the abdo- men is soft. Deep palpation on inspiration arrests his breathing. There is no organomegaly or distention. Blood tests are pending. Questions 1. What is the diagnosis? 2. What investigations does he require? 3. How would you manage him? 199 100 Cases in Emergency Medicine and Critical Care DISCUSSION This patient has acute cholecystitis. He has a probable history of gallstones and is now febrile and Murphy’s sign positive on examination. Most patients with gallstones are asymptomatic. However, complications of gallstones range from biliary colic, whereby gallstones irritate or temporarily block the biliary tract, to acute cholecystitis, which is an infection of the gallbladder sometimes due to obstruction of the cystic duct. Gallstones can also become trapped in the common bile duct (choledocholithia- sis) causing jaundice and potential ascending cholangitis, which refers to infection of the bili- ary tree. Ascending cholangitis classically presents with Charcot’s triad of fever, right upper quadrant (RUQ) pain and jaundice. It can be life-threatening. The majority of gallstones contain cholesterol but some contain pigment. Risk factors include pregnancy, elderly, .
