i CIES A CLINICAL I PRESENTATION ] OF CHRONIC ~=©CAL@ULUS ~CHOLECYS- TITS Prepared by ~ Manjida Rohmowt Ur mans (3nd year) smeacupation: q Adriano: Vteci baliapana , Araihagan, Pate of admimion? 09.03.2023 Pate of examivoti«n ’ 09.03.2023 fe the honptlal : Paychiou lan Name ' Sint Galimublah mudiaal callege € miford isd Unit! YI Bed no.' 26 Parctieularo gf he Student Name. Manyida Rahman oni s nit: 02af ir Po. Then he developed ie m right hypochreondia ion The pain 15 aadueky in noture, radiate to back, aggnaveted by fatty tan > relieved by “taking _— analgesien . daeasionally he pain associated with Vorniting since lant 6 mntwm.He used to omit 2-3. tien daily . The Vomit ane bile Staind, biter im — dngte, Contained partially ol food prin fe gre ty ok Hat with chile % igen a j ; pain He ve 0 be yaer Y Pow! hivrlony ” He pont hiwtony of g — Gandiovonavlan dineanc. ferwonal — wurtory + Non - smoker *Non-aleho holia *Mannied * Hygienie Favni)y \urtony He hon one daughter Zz me gon auve & ve simian type Bot dincone @ prenent in henee dh. ee drugn on , Tmmounization hurtony " Fenravniz-ed a.ccending +o En Sthedule . ‘i Tread ment hiatory He took edieine on HO avd mmercioning clopidogrel.a Re Cyanasis: Absent ~ Glubbing’ Absent Koi lony chic’ Absent Levaony chia’ Absent Oedema: Absent Dehydration: Absent Lymph ede: Not rolpable Neck vem: Not en gonged Puloc: 76 bpm B.P. 166/90 tan Hy Temperature’ Normal 4 Rupinration: 46 breeth/rnin Skin conditen’ Nonmal xine distin bution’ Nonna |9 Umbiticva’ Centrally placed Skin condition’? Norumal Visthle engorged veiw: Absent Grrtoin! Normal Pal P ath ” a. Superchieia | Hy perwithuria absent Temperature normal Tender absent b. Deep: ‘ Murphy 5 sign 4 Negative My sale quand * Hosenr _ ape Space on tught nda \ + Shifting duilienn f$Iuid Thnk? Absentee Avseultation Bowe sound! Prened Other. systemic excodminetian Reyealo normal Ainding Feaclunen Md, Johurvk lam, 45 yea of SG Salient hailing from vhah baliapara, araihazan ' _prunented wrth relght upper. abdomi . ; pe fon 2 yam. The pain yaaa dune, radiate ty back, aggna +ea Pr aah “ a Ne fever with — chi e. ay attack of pain. _ ae nn hurtony of itehing on bleed snawrfunian Hin bowel & bladder hobita are norumals” He har vo lintony of Cough, hasmopty pis jaundice , jaemaderurin , vrslen a on bone pain . Patient hon no systemic diseane Brn @ hen fanily maermleete suftening Guerenl erominctinn 9a ertially s i. norimal. On abdomna | ongan palpable , ynunphy’s sign tive . Othen systemic examin ouari nation - No ,F : Orfenurh'a| diagnosis " “+ fopte uleen diveane -Chnmia duodenal uleen - chronic qannie vleert * Chnonie panereatita Inventigationa fon. diagnosis USC: « Hepactobibiany system Renal system Lowen abdomen ‘ ge! lblodden, on: Sort aalevlun iM i — i Aaa rural small cortical SYSact (SGPT) 20 UL “ALP - 84 U/L Pel i secon — MRT of brain : hate prt | ict » hayte \efaet in beft occipital lobe ‘Lipone - 75 U/L fray Lone ~ 138 yf /£eR- 20 mm in 4st hour Fort genet ral anaenthoria + Conplcte blood aul (¢gc) count + ying routine examination a. 9 vmmol/L“Treatment Open chaleeystectorny Progra The patient vy tulatvely decling better offen tuatrent, follow - Up We patientn emditon immprtovi doy -by- 42. Ne Jurdhen pain, venting, Seven. . “Lerminattion