Natural

Pathophysiology Symptoms Findings Dx studies History Treatment

Biliary Pain  Intermittent • severe poorly Mild/ moderate • Ultrasonography After initial • Elective
obstruction of Epigastric or RUQ epigastic or RUQ • Oral attack, 30% laparoscopic
cystic duct. pain tenderness due to cholecystography have no cholecystectomy
 No acute • visceral pain attack with mild • Meltzer-Lyon test further possible with IOC
inflammation of growing in intensity residual symptoms • ERCP for stone
GB over 15 minutes and tenderness lasting removal or BD
remaining constant days. exploration if IOC
for 1-6 hrs, often • often findings shows stones.
with nausea. are normal.
• gas, bloating, LAB:
flatulence • usually normal
• elevated serum
bilirubin, alkaline
phosphatase, or
amylase levels
suggest
coexisting BD
stones
Cholecystitis  Impacted stone • 75% biliary pain. LAB: • Ultrasonography, 33% • NPO; fluids and
in cystic duct • RUQ radiating to • Leukocytosis • Scintigraphy, palpable electrolyte given.
causing acute back, right shoulder, with band forms. • CT scan GB, 20% Antibiotics given
inflammation of chest pain; usually > • Serum jaundice toxic cases/
GB. 6hrs. bilirubins, (mild) presence with
 Secondary • Nausea, aminotransferase, complications.
bacterial vomiting, fever and alkaline • Cholecystectomy
infection = 50% • (+) Murphy’s sign. phosphatase with IOC
may be slightly
elevated
Choledocholithiasi Gallstone in the • Maybe • PE Maybe • Ultrasonography – • Stone removal
s CBD causing aymptomatic. normal if may visualize CBD 50% during ERCP followed
- Stone in bile obstruction • Predisposes to obstruction is • ERCP in most cases by
duct even if it is cholangitis & intermittent. • EUS early laparoscopic
asymp, have to pancreatitis. LAB: • MRCP cholecystectomy.
do REMOVE. • (+) jaundice w/ • Elevated serum • Percutaneous THC
pain. bilirubin and
alkaline
phosphatase
**serum bilirubin >
10mg/dl suggests
malignant
obstruction.
• transient
“spike” in
aminotransferase
or amylase
suggests stone
passage.
Cholangitis • obstruction in • Charcot’s triad • Fever 95% • ERCP • relief of obstruction
the CBD causing (pain, jaundice, • RUQ • Percutaneous THC (endoscopic,
bile stasis and fever) 70% of tenderness 90% percutaneous,
• Bacterial patient • Jaundice 80% surgery)
superinfection of • Reynaud’s • Hypotension & • antibiotics;
stagnant bile pentad (pain, mental confusion covered g(-), and
• Early jaundice, fever, and 15% anaerobes
bacteremia altered mental • Peritoneal signs • supportive
status 15% • subsequent
&hypotension) LAB: cholecystectomy
• Mental confusion, • Leukocytosis
lethargy, and 80%
delirium suggest • elevated
sepsis. bilirubin, and ALP
• Blood culture
Appendicitis -Crampy/colicky -hypoactive BS -elevated WBC (shift May become Uncomplicated: Cefoxitin 2 gms
pain- diffuse but to left >/=10,000) gangrenous, single dose (adults) or 40 mg/kg
localizes to RLQ -direct and Ruptured: 16,000- perforated, or have IV single dose (children)
rebound 17000 abscess
-nausea, tenderness Or:
vomiting, loss of -adults: CT scan
appetite -involuntary Gentamicin 80-120 mg IV single
muscle guarding -children: ultrasound dose plus Clindamycin 600 mgs
-low grade IV single dose (adults)
fever (38.2-38.3) -Rovsing’s (press
LLQ) Complicated: Ertapenem 1 gm
-MANTRELS: IV single dose every 24 hrs
Migration of -Psoas sign (flex or
pain, Anorexia, hyperextend R Or:
Nausea, thigh)
Tenderness, Ciprofloxacin 400mg IV q 12
Rebound Pain, -Obturator sign hours plus Metronidazole 500
Elevated temp, (flex R thigh, R hip mg IV q 6hrs
Leukocyte internally rotates
count, shift to Surgical: Appendectomy
the left

Hyperthyroidism heart TSH, FT4, T3, Thyroid PTU, Methimazole (10-30mg OD

intolerance, scan to TID), Carbimazole, Beta
profuse Blockers: Propanolol
sweating, weight
loss, diarrhea, RAIA
palpitations,
fatigue, tremors Thyroidectomy

Hypothyroidism cold intolerance, Thyroid function test Thyroxine Replacement (L-

weight gain, tyroxine(Eltroxin/Thyrax): start
constipation, with 50-150mcg preparation.
Maintenance: 100mcg/day))
tiredness, dry
skin, brittle hair,
hoarse voice,
fatigue, difficulty
concentrating,

Thyroid -nodules, cervical Thyroid function test, Thyroidectomy, FNAB

tumors/cancer lymphadenopathy thyroid scan,
ultrasound, CT/MRI,
FNAB