HKCEM College Tutorial. A Lady with Right Upper Quadrant P ain. Author Dr. LEE KF, Dr. TANG CO, Dr. TAM MK Revised by DR CHAN CHI MING May 2013. Triage Notes. F/75 c/o: RUQ pain for 1 day PMH: DM, IHD, old PTB BP 172/78 P 96/min T 37.8 ºC. Triage Cat III.
HKCEM College Tutorial
Dr. LEE KF, Dr. TANG CO, Dr. TAM MK
DR CHAN CHI MING
Triage Cat III
What would you like to ask in the history ?
= RUQ pain + pyrexia + jaundice
UltrasoundWhat investigations would you order ?
CXR (erect film)
Amylase 89 U/L
Tn-I < 0.03 mmol/L
Glucose / H’stix 13.7 mmol/L
AF with ventricular rate of about 90/min
no acute ischemic changes
Thickened GB wall & peri-cholecystic fluid
Gallstone with echogenic foci & posterior acoustic shadow
Compatible with acute cholecystitis
Positive sonographic Murphy’s sign —tenderness elicited by pressing the gallbladder with the US probe
Major diagnostic criteria:
(5% of cases are not associated with gallstones)
(If patient does not have ascites, chronic liver disease & right heart failure)
(Indicative of impending perforation)
Any Questions ?