CASE ANALYSIS

CHOLELITHIASIS

Miftahuljannah S & Aditya Setyorini

Clinical Advisor : dr. RR Ignatia Sinta Murti, Sp.PD-KGEH

Risk factors
Theory Case 1 Case 2

Female sex - +

Family history - -

Obesity - -

High caloric diets + +

Low-fiber diets + -

Hormonal factors - +

Drugs - -

Sedentary life style + +

Rapid weight loss - +

Symptoms
Theory Case 1 Case 2

Pain located in the upper + +

abdomen

Episodic, steady, severe + +

pain

Pain radiating to the back + +

Fatty meal provoke the + -

pain

flatulence - +

nausea or vomiting - +

Fever - +

Jaundice + +
Labs. When indicated, may include:
Theory Case 1 Case 2
CBC + +

Liver function test + -

Amylase - +

Lipase - +
Feature of gallstone induced complication
Theory Case 1 Case 2
Cholecystitis Pancreatitis
Theory Case Theory Case
Pain site RUQ Epigastrium Epigastrium Epigastrium

Pain >3 hours Persistent Variable Variable

duration

mass - - +

Fever - +

Increased + +
WBC

Increased - + +
amylase
level
 Theory Case 1 Case 2
Cholecystitis Pancreatitis
theory Case Theory Case
Murphys
sign + + -

USG Common + -
duct
dilatation
BISAP and
Ranson + WBC =
criteria - - 36.500

Choledocolihi Choledocolih +
asis asis
pancreatitis
Diagnosis
Theory Case 1 Case 2
Abdominal + +
radiography (Used
primarily to exclude
other causes of
abdominal pain)

USG abdomen + +

MSCT abdomen w/ + +
contras

MRCP - -

- +
ERCP
Treatment
Theory Case 1 Case 2
Cholecystectomy + -

litholytic therapy - -

extracorporeal shock - -
wave lithotripsy
(ESWL)

ERCP with - +
Sphincterotomy
Thank you