chiaroscuro27 Posted February 4, 2011 Share Posted February 4, 2011 Chole has not been ruled out IMO. Neg ultrasound for stones, and neg Murphy's. What about a HIDA scan?? Link to comment Share on other sites More sharing options...
bradtPA Posted February 4, 2011 Author Share Posted February 4, 2011 Teaching point numero uno: not all patients present with just one problem, they may have several concurrently (and in my version of internal medicine, they may have a laundry list). This patient has three: gastritis, hypertension, and something else.... Link to comment Share on other sites More sharing options...
bradtPA Posted February 4, 2011 Author Share Posted February 4, 2011 HIDA scan was ordered, and the ejection fraction was 17% (normal 40% or higher) consistent with chronic cholecystitis. Teaching point numero dos: a negative US does not exclude gallbladder disease. A sick gallbladder makes stones, not stones a sick gallbladder. For those with negative US, you will have to f/u with a HIDA to really rule out cholecystitis. Link to comment Share on other sites More sharing options...
chiaroscuro27 Posted February 4, 2011 Share Posted February 4, 2011 Excellent teaching points! Thanks for the case. Keep 'em coming. Link to comment Share on other sites More sharing options...
Just Steve Posted February 4, 2011 Share Posted February 4, 2011 Nice to see I was on track for the most part, but it's drastically obvious I have no clue about what sort of tests are out there to utilize. Never knew what a HIDA scan was or that there was a breath test for h.pylori..pretty cool. Good stuff, thanks for sharing Link to comment Share on other sites More sharing options...
brannow Posted February 5, 2011 Share Posted February 5, 2011 With a chronic chole, why wouldn't you be peeling her off the ceiling when you did the Murphy? Link to comment Share on other sites More sharing options...
bradtPA Posted February 5, 2011 Author Share Posted February 5, 2011 What do you think? No exam test is going to be 100%. And which are you more likely to trust: an obese female in her fifties with chronic RUQ pain and mild RUQ tenderness has chole, or an obese female in her fifties with RUQ pain and a negative Murphy's does not? Link to comment Share on other sites More sharing options...
Guest guthriesm Posted February 7, 2011 Share Posted February 7, 2011 I had chronic choleocsystitis and never sought treatment- it was found on a HIDA scan run for a completely unrelated reason (ejection fraction at <11%); Murphy's sign negative and I am not an overweight woman in my 40s (I was 21 when I had it removed). Did have an u/s a few weeks after the scan - no stones; path report was lovely (and necrotic). Excellent case, good reminder that we can't make assumptions but that are are reasons for common situations! Link to comment Share on other sites More sharing options...
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