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Admission Conference May 24, 2011

Admission Conference May 24, 2011. Mark Anthony Melitante Leviste Ateneo School of Medicine and Public Health Batch 2013. General Data. JP 32 years old Male Roman Catholic Filipino. Chief Complaint. Gallstones on Ultrasound. History of Present Illness. 1 year PTC.

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Admission Conference May 24, 2011

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  1. Admission ConferenceMay 24, 2011 Mark Anthony Melitante Leviste Ateneo School of Medicine and Public Health Batch 2013

  2. General Data • JP • 32 years old • Male • Roman Catholic • Filipino

  3. Chief Complaint Gallstones on Ultrasound

  4. History of Present Illness 1 year PTC Patient was found to have a 0.3 cm polyp in Gallbladder via routine pre-employment ultrasound No medications given and procedures done Patient did not feel any pain

  5. History of Present Illness 1 year PTC Patient was advised to engage more in exercise and to change his diet.

  6. History of Present Illness Polyps were seen on routine pre-employment physical examination. The polyps increased to 0.6 cm in size. This prompted patient to seek second opinion. 1 mo. PTC

  7. History of Present Illness Repeat ultrasound revealed gallbladder stones, measuring about 0.6 cm each. Thus prompting admission for procedure. 1 mo. PTC

  8. Review of Systems • Unremarkable • Pertinent negatives • General symptoms: fever, weight changes, headache, dizziness • Skin: Rashes, changes in skin color (jaundice) • GI symptoms: nausea, vomiting, changes in bowel movements • GU symptoms: changes in urine color

  9. Past Medical History • Unremarkable • No history of other gastrointestinal diseases • No history of previous surgeries and hospitalization • No known allergies

  10. Family and Personal-Social History • Asthma – siblings • No known first and second degree relatives having the same symptoms • College Graduate (BS MT) • Occupation: Seafarer • Smoker, 11.25 pack-year • Occasional drinker • No history of illicit drug use • Diet include rice with pork, fish and veggies

  11. Physical Examination • Anthropometrics • Height: 175.5 cm • Weight: 91 kg. • BMI: 29.54 kg/m2 • Vital Signs • BP: 100/80 mmHg • HR: 90 beats/min., regular rate • RR: 24 breaths/min., regular rate • Temp: 36.2 degrees Celsius • Patient is coherent, alert, not in pain and respiratory distress

  12. Physical Examination • Unremarkable • Pertinent Negatives • HEENT: anicteric sclera • CP: normal chest expansion, clear BS, normal rate and rhythm, no wheezes, rales; PMI located at 5th ICS,LML, regular rate and rhythm, good S1 and S2, no heaves, thrills or lifts

  13. Physical Examination • Pertinent Negatives • Abdomen: protuberant, without visible pulsations and lesions, normoactive bowel sounds, no tenderness, organomegaly, negative Murphy’s sign, direct and rebound tenderness • Neurologic: Intact

  14. Salient Features SUBJECTIVE OBJECTIVE Normal PE findings Overweight based on BMI • 32/M • Gallstones on ultrasound • Diet include more on protein-rich food • Seafarer

  15. Assessment Cholelithiasis

  16. Cholelithiasis • Gallbladder stones • Formed due to abnormality in bile salt constituents • Two types: • Cholesterol • Pigment • Most are asymptomatic • Most common cause • Increased biliary secretion of cholesterol

  17. Cholelithiasis • Risk Factors: • High fat diet • Obesity • First degree relative who have cholelithiasis • Pregnancy • Prolonged parenteral nutrition • Race • Female sex hormones

  18. Cholelithiasis • Signs and Symptoms • Most are asymptomatic • Right upper quadrant pain, with radiation to interscapular area or shoulder • Jaundice • Fever

  19. Cholelithiasis • Differential Diagnoses • Gallbladder polyps • Peptic ulcer disease • Gastroesophageal Reflux (GER) • Irritable bowel syndrome • Hepatitis

  20. Cholelithiasis • Imaging Modalities • Abdominal/RUQ Ultrasound • Endoscopic retrograde Cholangiopancreatography • Abdominal CT Scan • Laboratory Studies • Bilirubin levels • Liver function tests

  21. Cholelithiasis • Treatment • Surgery: Cholecystectomy • Open • Laparoscopic • Gallstone Dissolution • Ursodeoxycholicacid

  22. Cholelithiasis • Possible complications • Cholecystitis • Pancreatitis • Cholangitis • Chronic cholelithiasis

  23. Plan Elective surgery via Laparoscopic Cholecystectomy

  24. Thank you for your attention! Admission Conference May 24, 2011 St. Martin de Porres Charity Hospital

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