Biliary colic without acute cholecystitis

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1. Acute cholecystitis: This is inflammation of the gallbladder. It is caused by a blockage of the bile duct, which can lead to infection. The pain is typically more severe than biliary colic, and it is often accompanied by fever, nausea, and vomiting.
2. Duodenal ulcer: This is an ulcer in the lining of the duodenum, the first part of the small intestine. It is caused by the bacterium Helicobacter pylori. The pain is typically located in the upper abdomen, and it is often worse after eating. It can be accompanied by nausea and vomiting.

Diagnostics The following tests can be used to diagnose the different conditions:

• Blood tests: These tests can be used to check for inflammation and infection.
• Ultrasound: This test can be used to visualize the gallbladder and bile ducts. It can be used to identify gallstones and inflammation of the gallbladder.
• CT scan: This test can also be used to visualize the gallbladder and bile ducts. It is more sensitive than ultrasound for detecting gallstones.
• Endoscopic ultrasound: This test involves inserting a small ultrasound probe into the stomach. It is the most sensitive test for detecting gallstones.

Management The management of the different conditions depends on the diagnosis:

• Biliary colic without cholecystitis: This condition is usually treated with pain medication and fluids. If the pain is severe, a cholecystectomy (removal of the gallbladder) may be necessary.
• Acute cholecystitis: This condition is usually treated with antibiotics and pain medication. A cholecystectomy may be necessary if the condition does not improve with medical treatment.
• Duodenal ulcer: This condition is usually treated with antibiotics and acid-suppressing medications. If the ulcer does not heal with medical treatment, surgery may be necessary.

Conclusion The most likely diagnosis in this case is biliary colic without cholecystitis. The patient's history and physical examination are consistent with this diagnosis. The ultrasound findings are also consistent with this diagnosis. The patient was treated with pain medication and fluids, and his symptoms improved. He was discharged from the hospital with instructions to follow up with his doctor for further care.  

Sample Solution

     

A 42-year-old male with a history of GERD presented to the clinic complaining of moderate abdominal pain in the right upper quadrant. The pain started after he consumed a large fatty meal. The pain radiated to his back. He denied fever, chest pain, diarrhea, or any change in his bowel movements. He admitted to vomiting. He consumes alcohol on the weekends and quit smoking 10 years ago. Physical examination was normal. Murphy's sign was negative.

Differential Diagnoses

The differential diagnoses for this case include:

1. Biliary colic without cholecystitis: This is the most likely diagnosis. It is caused by the passage of a gallstone through the bile duct. The pain is typically sudden and severe, and it is often located in the right upper quadrant. It can radiate to the back or shoulder. The pain may be accompanied by nausea and vomiting.