From my chamber: 14th September 2018
Total patients: 35
Pediatric patients(age < 10 years): 5
Male patients: 32
Female patients: 3
- Acute cholecystitis: The patient was suffering from pain in the right upper abdomen for last 1 week
- Impacted wax in both ears: Patient came with mild deafness and pain in the both ears
- Allergic dermatitis: The patient was a construction worker. His allergy was due to cement.
- Multiple joints pain with gum bleeding: RF(rheumatoid factor) was negative but blood sugar was sky high!
- Cervical lymph node enlargement: Got two patients with similar complaints. Gave them advice to go for tissue diagnosis.
Acute cholecystitis:
image source
Cholecystitis means inflammation of the gall bladder (GB). GB resides in the under part of the liver in the right upper quadrant (RUQ) of the abdomen. Gall bladder acts as the storage unit of bile which is produced from the liver. Bile consists of mainly three components; cholesterol, bile pigments (comes from broken hemoglobin) and phospholipids. Under normal condition, the ratio of the each component is maintained strictly so that there will be no precipitate or sludge. If the ratio is changed anyhow, the process of formation of stone starts. Acute cholecystitis follows when a stone or sludge impacts in the neck of the GB.
An impacted stone in the neck of GB image source
Main features of acute cholecystitis:
- Severe pain in the RUQ or in the epigastric are (upper mid * part); sometimes patient may feel pain in his or her right shoulder too
- Vomiting
- Fever
Murphy’s sign:
If a patient go to a doctor with the above mentioned features, the doctor will do a specific examination to establish the diagnosis (USG if the gold standard investigation for such patient). He will put his thumb over the patient’s RUQ and ask the patient to breathe in. If the pain increases and patient stops the breathing (arrest of inspiration) due to pain, it is almost confirm that pathology is in the GB. Same process should be done on the left side (exactly same point on the left side) following first one. If patient does not feel pain in the left side the diagnosis will be more appropriate.
This video will help you understanding the procedure:
Presents Useful Medical Questions and Answers for medical personals
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