Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with colicky right upper quadrant (RUQ) abdominal pain, associated with nausea and intermittent episodes of jaundice. Pain is persistent, radiating to the right scapula, and exacerbated by fatty meals. No history of fever or chills (unless cholangitis is suspected). Review of systems positive for dark urine and acholic stools.
Clinical Examination Findings
Vitals stable. Abdominal exam reveals tenderness in the RUQ. Murphy’s sign may be negative if chronic, but guarding or rebound tenderness may be present if complications exist. Scleral icterus noted. No palpable gallbladder mass (Courvoisier’s sign absent/present). Bowel sounds present.
Treatment Protocol
Plan: 1. NPO status. 2. IV fluid resuscitation and electrolyte correction. 3. Analgesia and antiemetics. 4. Urgent ERCP (Endoscopic Retrograde Cholangiopancreatography) for stone extraction. 5. Subsequent laparoscopic cholecystectomy to prevent recurrence. 6. Prophylactic antibiotics if cholangitis is suspected.