GB STONE WITH CBD STRICTURES and its mangement .pptx

cbd stone

1. DR. NAHID AHMED SANA GENERAL SURGERY PGT 1ST YEAR JIMSH Chronic Calculus Cholecystitis with(?) CBD Stricture

2. PATIENT PARTICULARS Name: Mrs. I. Roy Age: 52 years Gender: Female Religion- Hinduism Occupation: Homemaker Address: Chakkashipur, Nodakhali Date of Admission: 04/05/2024 Marital status: Married

3. She is follow up case of Chronic calculus cholecystitis , at present no complaints of pain abdomen. CHIEF COMPLAINTS

4. The patient was apparently well 3 months back when she developed pain in the right upper abdomen which was insidious in onset, gradually progressive, dull aching in nature, radiating towards back.The pain was associated with nausea and one episode of vomiting.Vomiting was non-projectile in nature, contained bile.She also complained of headache and neck pain. No history of Jaundice,Fever, persistent headache, weight loss, anorexia, pruritus, cough and black stool. HISTORY OF PRESENT ILLNESS

5. Known Hypertensive, on regular medication since last 2 year Antral Gastritis with RUT positive ( Treated with HP Kit , April,2024) No previous surgical history No history of contact with Tuberculosis patients. PAST HISTORY

6. PERSONAL HISTORY Appetite: Normal Diet: mixed Indian diet Bowel habit: Normal Sleep: Normal Addiction History: None Allergic History: no known allergies Married with one child, NVD, Post menopausal 8 year back.

7. Mother: CVA ( expired) Father: Hypertensive,diabetic , Siblings: History of cholecystectomy in elder sister FAMILY HISTORY

8. GENERAL SURVEY Patient is alert and oriented to person, place, and time Average built Well-nourished Moderate pallor No icterus, cyanosis, or clubbing No significant weight loss No signs of dehydration or edema No cervical lymphadenopathy Vital signs within normal limits No palpable L.N No Venous engorgement

9. LOCAL EXAMINATION INSPECTION: Abdomen is not distended. umbilicus is central, inverted. no visible pigmentation, striae all quadrants moving equally with respiration. No visible pulsations, peristalsis. No visible engorged veins.

10. LOCAL EXAMINATION PALPATION: Superficial palpation: no local rise of temperature, no tenderness, no obvious swelling. Deep palpation: no tenderness, spleen not palpable , liver not enlarged.

11. Respiratory: Clear breath sounds bilaterally without wheezing or crackles Cardiovascular: Regular rhythm with no murmurs or gallops Peripheral pulses are palpable and symmetric Neurological: No focal neurological deficits OTHER SYSTEMIC EXAMINATION

12. Investigation Summary HB 10.3 TLC 10K Platelets 1.75 L PT- INR 14.2 / 1.1 Bilirubin 0.4 Direct 0.2 Indirect 0.2 ALP 223 Sodium 133 Potassium 4.4 Serology Non Reactive Blood Group B Positive Routine Blood tests CA 19.9 12.91. ( Normal < 37 ) AFP 2.23. ( Normal- < 6.5 ) CEA <2.79. ( Normal < 5.09 ) Tumor Markers

13. USG W/A GB - Multiple hyperechoic structures.largest- 0.92 at G.B. lumen 2. C.B.D- 0.7 C M

14. R EPORTS MRCP REPORT : report suggestive of Cholelithiasis Dilated CBD with gradual distal tapering without any radiodense calculus,suggesting distal CBD stricture 26*24mmT2 hyperintense cyst in segment 5 of liver. Grade 2 fatty liver with mild hepatomegaly

15. A 52 year old post menopausal hypertensive female patient presented with complaints of pain in the right upper abdomen since the last 2 months. The pain was insidious in onset,gradually progressive,intermittent in nature,radiating to the back. The pain was associated with single episode of vomiting which was non-projectile in nature contained bile. On general examination is Within normal limits , per abdominal examination is Within normal limits .As per lab and radiological investigations patient is having Chronic calculus cholecystitis with distal CBD stricture Liver cyst at segment V . SUMMARY

16. Thank you!