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.
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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 ?