Health Disorder Empowerment May 14, 2022

Course– objective - for 1400H - 1500H

Fundamentals laypeople to have an Via Zoom
and understanding of the
Generalities in FUNDAMENTALS and
Medical GENERALITIES in
Management MEDICAL
of RUQ MANAGEMENT of
ABDOMINAL RUQ ABDOMINAL
PAIN and PAIN and
GALLBLADDER GALLBLADDER
RUQ – Right Upper Quadrant
Disorders DISORDERS.
Health Disorder Empowerment
Course– objective - for
Fundamentals laypeople to have an ROJoson PEP Talk
and understanding of the
I have a Patient
Generalities in FUNDAMENTALS and
Empowerment
Medical GENERALITIES in Program in which I
Management MEDICAL like to empower the
of RUQ MANAGEMENT of lay people or
ABDOMINAL RUQ ABDOMINAL patients to take
PAIN and PAIN and control in the
management of
GALLBLADDER GALLBLADDER
RUQ – Right Upper Quadrant their health.
Disorders DISORDERS.
 There are 3 courses
in the PEP Talk.
I completed the Core
Course on October 9,
2021.
 From October 23,
2021 onwards, I have
been tackling Health
Disorder and Health
Issue Courses. This
may take 3 years or
longer.
Health Disorder Empowerment
My PEP TALK today
Course– objective - for is entitled:
Fundamentals laypeople to have an Fundamentals and
and understanding of the Generalities in
Generalities in FUNDAMENTALS and Medical
Medical GENERALITIES in Management of
Management MEDICAL RUQ ABDOMINAL
of RUQ MANAGEMENT of PAIN and
ABDOMINAL RUQ ABDOMINAL GALLBLADDER
PAIN and PAIN and Disorders. This is
GALLBLADDER GALLBLADDER part of the Health
RUQ – Right Upper Quadrant Disorder Course.
Disorders DISORDERS.
Fundamentals and
Generalities in
Contents of ABDOMINAL DISORDERS March 19, 2022
1400H - 1500H
Medical [OVERVIEW] Via Zoom
Management of • What is an abdominal disorder?
RUQ ABDOMINAL • What are the different types of abdominal
PAIN and disorders?
GALLBLADDER • What are the causes of abdominal disorders?
Disorders • How common are the abdominal disorders?
• Clinical diagnosis of abdominal disorders?
• Paraclinical diagnostic procedures for • Abdominal Pain
abdominal disorders? • Abdominal Mass
• Basic treatment modalities for abdominal • Abdominal Obstruction
disorders? • Abdominal Bleeding
• Jaundice
Fundamentals and
Generalities in
Contents of ABDOMINAL PAIN March 26, 2022
1400H - 1500H
Medical [OVERVIEW] Via Zoom
Management of • What is an abdominal pain?
RUQ ABDOMINAL • What are the different types of abdominal
PAIN and pain?
GALLBLADDER • What are the causes of abdominal pain?
Disorders • How common are the abdominal pain?
• Clinical diagnosis of abdominal pain?
• Paraclinical diagnostic procedures for
abdominal pain?
• Basic treatment modalities for abdominal
pain?
Fundamentals and
Generalities in
Contents of RLQ ABDOMINAL PAIN April 2, 2022
1400H - 1500H
Medical and APPENDICITIS Via Zoom
Management of • What is a RLQ abdominal pain?
RUQ ABDOMINAL • What are the different types of RLQ abdominal
PAIN and pain?
GALLBLADDER • What are the causes of RLQ abdominal pain?
Disorders • How common are RLQ abdominal pain?
• Clinical diagnosis of RLQ abdominal pain?
• Paraclinical diagnostic procedures for RLQ
abdominal pain?
• Basic treatment modalities for RLQ abdominal
pain?
• Management of APPENDICITIS
Fundamentals and
Generalities in
Contents of RUQ ABDOMINAL PAIN May 14, 2022
1400H - 1500H
Medical and GALLBLADDER Disorders Via Zoom
Management of • What is a RUQ abdominal pain?
RUQ ABDOMINAL • What are the different types of RUQ abdominal
PAIN and pain?
GALLBLADDER • What are the causes of RUQ abdominal pain?
Disorders • How common are RUQ abdominal pain?
• Clinical diagnosis of RUQ abdominal pain?
• Paraclinical diagnostic procedures for RUQ
abdominal pain?
• Basic treatment modalities for RUQ abdominal
pain?
• Management of GALLBLADDER DISORDERS
Fundamentals and Definition of Terms in Title AND Delimitation of
Generalities in Coverage of Talk:
Medical
Management of Fundamentals – simplest and essential facts and
RUQ ABDOMINAL
theories which can serve as a basis or foundation
PAIN and
GALLBLADDER and support for advanced information
Disorders
Generalities – general statements of info, not
covering specifics and details

Medical Management – diagnosis and treatment

by physicians
Fundamentals and • What is a RUQ abdominal pain?
Generalities in
Medical
Management of
RUQ ABDOMINAL
PAIN and
GALLBLADDER
Disorders
 What is the
Fundamentals and • What is a RUQ abdominal pain?
Generalities in implication of the
Medical RUQ stands for right upper quadrant. RUQ abdominal
Management of RUQ abdominal pain means pain or unpleasant pain?
RUQ ABDOMINAL sensation in the right upper quadrant of the All the tissues and
PAIN and abdomen. RUQ is the location of the pain. organs in the RUQ
GALLBLADDER area could be the
Disorders source of the RUQ
abdominal pain.
• Abdominal wall
• Peritoneal lining
• Internal
abdominal organs
in the area
Fundamentals and • What are the different types of RUQ abdominal
Generalities in pain?
Medical
Management of
RUQ ABDOMINAL
PAIN and
GALLBLADDER
Disorders
Fundamentals and • What are the different types of RUQ abdominal
Generalities in pain?
Medical
Management of Essentially, the different types of RUQ abdominal
RUQ ABDOMINAL pain will be based on the origin of the unpleasant
PAIN and sensation on/in the area:
GALLBLADDER
Disorders • abdominal wall
• lining of the abdominal cavity or
peritoneum
• solid organs
• hollow organs inside the abdominal
cavity in the RUQ
Fundamentals and • What are the different types of RUQ abdominal ROJoson GENERAL
Generalities in pain? CLASSIFICATION OF
Medical TYPES of unpleasant
Management of Essentially, the different types of RUQ abdominal sensation that can
RUQ ABDOMINAL pain will be based on the origin of the unpleasant used as CUES:
PAIN and sensation on/in the area: • Abdominal wall –
GALLBLADDER
constant,
Disorders • abdominal wall superficial
• lining of the abdominal cavity or • Peritoneal lining –
peritoneum constant, deeper
• solid organs • Sold organs –
• hollow organs inside the abdominal constant, deep
cavity in the RUQ • Hollow organs –
crampy or colicky
Fundamentals and • What are the causes of RUQ abdominal pain?
Generalities in
Medical
Management of
RUQ ABDOMINAL
PAIN and
GALLBLADDER
Disorders
Fundamentals and • What are the causes of RUQ abdominal pain?
Generalities in
Medical All the tissues and organs in the RUQ area could
Management of be the source of the RUQ abdominal pain.
RUQ ABDOMINAL • Abdominal wall
PAIN and • Peritoneal lining
GALLBLADDER • Internal abdominal organs in the area (hollow
Disorders and solid organs)
• Liver
• Gallbladder
• Pancreas
• Right colon (ascending colon)
• Small intestines
• Right kidney
Fundamentals and • What are the causes of RUQ abdominal pain?
Generalities in
Medical All the tissues and organs in the RUQ area could
Management of be the source of the RUQ abdominal pain.
RUQ ABDOMINAL • Abdominal wall
All kinds of medical
PAIN and • Peritoneal lining
conditions and
GALLBLADDER • Internal abdominal organs in the area (hollow
diseases in these
Disorders and solid organs) tissues and organs
• Liver
can cause abdominal
• Gallbladder
pain.
• Pancreas
• Right colon (ascending colon) • Inflammation
• Small intestines • Tumors
• Right kidney • Stones
Fundamentals and • How common are RUQ abdominal pain?
Generalities in
Medical
Management of
RUQ ABDOMINAL
PAIN and
GALLBLADDER
Disorders
Fundamentals and • How common are RUQ abdominal pain?
Generalities in
Medical
Management of • COMMON
RUQ ABDOMINAL
PAIN and
GALLBLADDER
Disorders
• No concrete data comparing
frequency of pains in other
quadrants
Fundamentals and • Clinical diagnosis of RUQ abdominal pain?
Generalities in
Medical
Management of
RUQ ABDOMINAL
PAIN and
GALLBLADDER
Disorders
Fundamentals and • Clinical diagnosis of RUQ abdominal pain?
Generalities in
Medical Processes used in clinical diagnosis of RUQ
Management of abdominal pain:
RUQ ABDOMINAL • Pattern recognition process means realization All kinds of medical
PAIN and that the patient’s presentation conforms to a conditions and
GALLBLADDER
previously learned picture or pattern of diseases in these
Disorders
disease. tissues and organs
can cause abdominal
• Prevalence process means choice of a diagnosis
pain.
is based on the frequency of occurrence of the
disease in a certain locality, in a certain age and • Inflammation
sex group, and in the affected organ and • Tumors
system. • Stones
Fundamentals and • Clinical diagnosis of RUQ abdominal pain?
Generalities in
Medical TIPS:
Management of
RUQ ABDOMINAL BASIC EVALUATION METHODS: All kinds of medical
PAIN and conditions and
GALLBLADDER • HISTORY TAKING – TO GET SYMPTOMS
diseases in these
Disorders • PHYSICAL EXAMINATION – TO GET SIGNS
tissues and organs
can cause abdominal
pain.
CLINICAL DIAGNOSIS • Inflammation
• Tumors
• Stones
Fundamentals and • Clinical diagnosis of RUQ abdominal pain?
Generalities in
Medical TIPS in evaluating / diagnosing RUQ ABDOMINAL
Management of PAIN upon onset of pain (any unpleasant
RUQ ABDOMINAL sensation) All kinds of medical
PAIN and conditions and
GALLBLADDER • Try to determine the type of pain as best as
diseases in these
Disorders you can. tissues and organs
• Feel for any associated symptoms like fever,
can cause abdominal
nausea, vomiting, diarrhea, etc. pain.
• Recall any antecedent /precipitating events
that may lead to the pain. • Inflammation
• Monitor closely the pain – course and its • Tumors
associated symptoms. • Stones
Fundamentals and • Clinical diagnosis of RUQ abdominal pain? A simple classification
Generalities in of pain that may have
Medical TIPS in evaluating / diagnosing RUQ ABDOMINAL diagnostic import:
Management of PAIN upon onset of pain (any unpleasant
RUQ ABDOMINAL sensation) Crampy / colicky pain
PAIN and
– hollow organ
GALLBLADDER • Try to determine the type of pain as best as
involvement
Disorders you can.
• Feel for any associated symptoms like fever,
Non-crampy / colicky
nausea, vomiting, diarrhea, etc. pain - may be from
• Recall any antecedent /precipitating events
any source even
that may lead to the pain. hollow organ
• Monitor closely the pain – course and its
involvement
associated symptoms.
Fundamentals and • Clinical diagnosis of RUQ abdominal pain? Associated symptoms
Generalities in may give clues to the
Medical TIPS in evaluating / diagnosing RUQ ABDOMINAL diagnosis such as
Management of PAIN upon onset of pain (any unpleasant • Fever – an
RUQ ABDOMINAL sensation) inflammation /
PAIN and • Try to determine the type of pain as best as infection may be going
GALLBLADDER you can. on
Disorders • Vomiting – possible
• Feel for any associated symptoms like fever,
obstruction
nausea, vomiting, diarrhea, urinary • Diarrhea – possible
disturbance, etc. enteritis
• Recall any antecedent /precipitating events • Urinary disturbance –
that may lead to the pain. possible kidney
• Monitor closely the pain – course and its problem
associated symptoms.
Fundamentals and • Clinical diagnosis of RUQ abdominal pain? An antecedent /
Generalities in precipitating event
Medical TIPS in evaluating / diagnosing RUQ ABDOMINAL may give clues to the
Management of PAIN upon onset of pain (any unpleasant diagnosis such as
RUQ ABDOMINAL sensation)
PAIN and • Try to determine the type of pain as best as • History of recent
GALLBLADDER you can. vehicular accident -
Disorders • Feel for any associated symptoms like fever, possible blunt
nausea, vomiting, diarrhea, urinary injury
disturbance, etc.
• Recall any antecedent /precipitating events • History of exposure
that may lead to the pain. to people with
• Monitor closely the pain – course and its jaundice – possible
associated symptoms. hepatitis
Fundamentals and • Clinical diagnosis of RUQ abdominal pain? After onset,
Generalities in monitoring closely the
Medical TIPS in evaluating / diagnosing RUQ ABDOMINAL course of the
Management of PAIN upon onset of pain (any unpleasant abdominal pain may
RUQ ABDOMINAL sensation) give clues to the
PAIN and • Try to determine the type of pain as best as diagnosis such as
GALLBLADDER you can.
Disorders • Feel for any associated symptoms like fever, • Over time, the type
nausea, vomiting, diarrhea, urinary of pain may be
disturbance, etc. clearer in character
• Recall any antecedent /precipitating events to enable pattern
that may lead to the pain. recognition of a
• Monitor closely the pain – course and its medical condition
associated symptoms. or disease.
Fundamentals and • Clinical diagnosis of RUQ abdominal pain? After onset,
Generalities in monitoring closely the
Medical TIPS in evaluating / diagnosing RUQ ABDOMINAL course of the
Management of PAIN upon onset of pain (any unpleasant abdominal pain may
RUQ ABDOMINAL sensation) give clues to the
PAIN and • Try to determine the type of pain as best as diagnosis such as
GALLBLADDER you can. • Over time, the
Disorders • Feel for any associated symptoms like fever, appearance of
nausea, vomiting, diarrhea, urinary associated
disturbance, etc. symptoms may
• Recall any antecedent /precipitating events enable pattern
that may lead to the pain. recognition of a
• Monitor closely the pain – course and its medical condition
associated symptoms. or disease.
Fundamentals and • Clinical diagnosis of RUQ abdominal pain?
Generalities in
Medical TIPS in evaluating / diagnosing RUQ ABDOMINAL
Management of PAIN upon onset of pain (any unpleasant
RUQ ABDOMINAL sensation)
PAIN and
GALLBLADDER PHYSICAL EXAMINATION
Disorders
LOOK AND PALPATE SIGN-based
evaluation
Fundamentals and • Clinical diagnosis of RUQ abdominal pain?
Generalities in
Medical TIPS:
Management of BASIC EXAMINATION OF THE ABDOMEN:
RUQ ABDOMINAL LOOK AND PALPATE
PAIN and
GALLBLADDER • LOOK for unusual bulge particularly in the RUQ
Disorders that may suggest mass. SIGN-based
• LOOK for abdominal distention that may evaluation
suggest intestinal obstruction or mass.
• PALPATE for possible presence of mass.
• PALPATE for presence of tenderness (pain on
pressure) – if present, evaluate further.
Fundamentals and • Clinical diagnosis of RUQ abdominal pain?
Generalities in
Medical TIPS:
Management of In looking for the SPECIFIC CAUSE of RUQ
RUQ ABDOMINAL ABDOMINAL PAIN, Clinical Diagnosis
PAIN and use PATTERN RECOGNITION of a particular General Statements:
GALLBLADDER medical condition or disease and PREVALENCE
Disorders process in those with similar presentation of RUQ abdominal pain
symptoms and signs. secondary to:
• Non-specific
cause
• Primary clinical diagnosis: Most probable • Specific cause
• Secondary clinical diagnosis: Second most (specify the
probable disease)
Fundamentals and • Clinical diagnosis of RUQ abdominal pain?
Generalities in
Medical TIPS:
Management of In looking for the SPECIFIC CAUSE of RUQ
RUQ ABDOMINAL ABDOMINAL PAIN,
PAIN and use PATTERN RECOGNITION of a particular
GALLBLADDER medical condition or disease and PREVALENCE
Disorders process in those with similar presentation of If there are cues for
symptoms and signs. a specific disorder,
such as mass or
obstruction, then
• Primary clinical diagnosis: Most probable specify the disorder
• Secondary clinical diagnosis: Second most and then look for
probable the specific cause.
Fundamentals and • Clinical diagnosis of RUQ abdominal pain?
Generalities in
Medical TIPS:
Management of In looking for the SPECIFIC CAUSE of RUQ
RUQ ABDOMINAL ABDOMINAL PAIN,
PAIN and use PATTERN RECOGNITION of a particular
GALLBLADDER medical condition or disease and PREVALENCE If there are cues for
Disorders process in those with similar presentation of a specific disorder
symptoms and signs. and a specific
disease, then specify
the disorder and the
• Primary clinical diagnosis: Most probable specific disease.
• Secondary clinical diagnosis: Second most That will be the
probable diagnosis.
Fundamentals and • Clinical diagnosis of RUQ abdominal pain?
Generalities in
Medical In patients with RUQ ABDOMINAL PAIN but
Management of without clear-cut CUES for
RUQ ABDOMINAL • Abdominal mass
PAIN and • Abdominal obstruction Early stage of medical
GALLBLADDER and ABDOMINAL PAIN is mild and with no clear- condition or disease
Disorders cut characteristics and with no CUES for a specific or mild medical
disease whatsoever, condition in the
DIAGNOSIS is usually “Non-specific RUQ sources of pain
abdominal pain”. [This has to be monitored usually produces NO
afterwards.] distinct character or
nature. (Just mild
feeling of discomfort!)
Fundamentals and • Clinical diagnosis of RUQ abdominal pain?
Generalities in
Medical In patients with RUQ ABDOMINAL PAIN but
Management of without clear-cut CUES for
RUQ ABDOMINAL • Abdominal mass
PAIN and • Abdominal obstruction
GALLBLADDER and ABDOMINAL PAIN is mild and with no clear-
Disorders cut characteristics and with no CUES for a specific At times, watchful
disease whatsoever, waiting may allow
DIAGNOSIS is usually “Non-specific RUQ more distinct
abdominal pain”. [This has to be monitored character or nature of
afterwards.] the unpleasant feeling
to show up, thereby
facilitating diagnosis.
 Some abdominal
Fundamentals and • Clinical diagnosis of RUQ abdominal pain? conditions and
Generalities in diseases have typical
Medical Onset and course of pain – aids in clinical
diagnosis courses.
Management of
RUQ ABDOMINAL
Some have chronic
PAIN and • Acute or recent - about a week or two and recurrent track
GALLBLADDER • Chronic – lasting for about 3 months records – such as
Disorders • Recurrent – 3 episodes within 3 months chronic cholecystitis.
• Progressive – increasing in intensity
Others just one bout
or rarely recur.

Progressive connotes
serious diagnosis.
 Some abdominal
Fundamentals and • Clinical diagnosis of RUQ abdominal pain? conditions and
Generalities in diseases have typical
Medical Severity of pain – aids in clinical diagnosis severity score.
Management of
RUQ ABDOMINAL • Mild Some are usually
PAIN and • Moderate mild. Some usually
GALLBLADDER • Severe (of greatest urgency) moderate in pain.
Disorders Some usually severe.
SEVERE PAIN – aside from
implying greatest urgency in Example: pain caused
medical treatment, it also has a by gallbladder stones
connotation in diagnosis and causing acute
subsequent treatment. Example: obstruction will have
ACUTE ABDOMEN severe pain.
 Sometimes the
Fundamentals and • Clinical diagnosis of RUQ abdominal pain? specific cause of the
Generalities in acute abdomen
Medical ACUTE ABDOMEN is a condition, usually with cannot be definitely
Management of severe abdominal pain, that demands urgent established.
RUQ ABDOMINAL attention and treatment. It is enough for the
PAIN and physician to decide
GALLBLADDER ACUTE SURGICAL ABDOMEN is a condition, whether it is a
Disorders usually with severe abdominal pain, that SURGICAL or NON-
demands urgent attention and operative SURGICAL abdomen.
treatment.
This is a special
ACUTE NON-SURGICAL ABDOMEN is a condition category of clinical
that demands urgent attention and non-operative diagnosis of
treatment. abdominal pain.
Fundamentals and • Paraclinical diagnostic procedures for RUQ
Generalities in abdominal pain?
Medical
Management of
RUQ ABDOMINAL
PAIN and
GALLBLADDER
Disorders
Fundamentals and • Paraclinical diagnostic procedures for RUQ
Generalities in abdominal pain?
Medical
Management of Common instrumental and laboratory diagnostic
RUQ ABDOMINAL procedures for RUQ ABDOMINAL PAIN:
PAIN and
GALLBLADDER • Imaging procedures (x-rays – plain / with
Disorders barium dye; ultrasound; CT scan; MRI; PET
scan; etc.)
• Endoscopy (upper - esophagogastroscopy /
lower – colonoscopy, sigmoidoscopy,
proctoscopy)
• Blood tests (CBC; liver function tests; tumor
markers; etc.)
Fundamentals and • Paraclinical diagnostic procedures for RUQ
Generalities in abdominal pain?
Medical
Management of
RUQ ABDOMINAL The foremost indication for a paraclinical
PAIN and diagnostic procedure can be stated this
GALLBLADDER way:
Disorders

if you are not certain on the primary

clinical diagnosis and you need to be
certain or be more certain before
treatment, then go for a paraclinical
diagnostic procedure.
Fundamentals and • Paraclinical diagnostic procedures for RUQ
Generalities in As a rule, there is no need
abdominal pain?
Medical for a paraclinical
Management of diagnostic procedure if:
To decide on indication of the paraclinical
RUQ ABDOMINAL • you are quite
PAIN and diagnostic procedure,
certain of your
GALLBLADDER the physician uses two processes – primary clinical
Disorders
- degree of certainty on the primary diagnosis.
clinical diagnosis and • treatment plans for
primary and
- comparison of the treatment plans for secondary
the primary and secondary clinical diagnoses are the
diagnoses. same.
Fundamentals and • Paraclinical diagnostic procedures for RUQ
Generalities in abdominal pain?
Medical
Management of Competencies required of physicians managing
RUQ ABDOMINAL
RUQ abdominal pain:
PAIN and
GALLBLADDER • Know the uses and indications of all known
Disorders instrumental and laboratory diagnostic
procedures for abdominal pain.
• Use as needed and indicated.
• Select the most cost-effective one using the
BRCA process.
• Know how to interpret the results.
Fundamentals and • Paraclinical diagnostic procedures for RUQ
Generalities in abdominal pain?
Medical
Management of BRCA Process in selecting diagnostic procedures
RUQ ABDOMINAL
PAIN and Procedures Benefit Risk Cost Availability
GALLBLADDER (goal – to
be more
Disorders definite on
the
diagnosis)

Option1        
Option2        
Option3        
Fundamentals and • Clinical diagnosis of RUQ abdominal pain?
Generalities in
Medical ACUTE ABDOMEN is a condition, usually with
Management of severe abdominal pain, that demands urgent
RUQ ABDOMINAL attention and treatment.
PAIN and In patients with ACUTE SURGICAL
GALLBLADDER ACUTE SURGICAL
ABDOMEN, NO ABDOMEN
TIME shouldis a condition,
be wasted on
Disorders usually with severe abdominal pain, that
paraclinical diagnostic procedures just to
demands urgent attention and operative
establish
treatment.the definite cause. A surgeon
should operate without establishing the
specific cause. The operation
ACUTE NON-SURGICAL ABDOMEN is can serve as
a condition
that paraclinical
the demands urgent attentionprocedure
diagnostic and non-operative
as it
treatment.
will establish the cause.
Fundamentals and • Basic treatment modalities for RUQ abdominal
Generalities in pain?
Medical
Management of
RUQ ABDOMINAL
PAIN and
GALLBLADDER
Disorders
Fundamentals and • Basic treatment modalities for RUQ abdominal
Generalities in pain?
Medical
Management of SPECIFIC DISEASE SURGICAL / POTENTIALLY SURGICAL / NON-SURGICAL
RUQ ABDOMINAL
PAIN and W
GALLBLADDER X
Disorders Y
Z

• Surgical – outright surgical

• Non-surgical – non-surgical at all times (no operation)
• Potentially surgical – surgical only when needed
Fundamentals and • Basic treatment modalities for RUQ abdominal Surgical Treatment:
Generalities in pain? • Drainage of
Medical infections
Management of Examples of OUTRIGHT SURGICAL ABDOMEN (abscesses)
RUQ ABDOMINAL • Acute surgical abdomen • Removal (-ectomy
PAIN and • Complete intestinal obstruction such as
GALLBLADDER • Peritonitis secondary to ruptured liver abscess
Disorders cholecystectomy)
• Resectable tumors • Repair (-rrhaphy
such as
enterorrhaphy)
• Surgical – outright surgical
• Non-surgical – non-surgical at all times (no operation)
• Potentially surgical – surgical only when needed
Fundamentals and • Basic treatment modalities for RUQ abdominal Surgical Treatment:
Generalities in pain? • Drainage of
Medical infections
Management of Examples of POTENTIALLY SURGICAL ABDOMEN (abscesses)
RUQ ABDOMINAL • Asymptomatic gallbladder stones • Removal (-ectomy
PAIN and • Asymptomatic gallbladder polyps such as
GALLBLADDER • Incomplete intestinal obstruction
Disorders cholecystectomy)
• Asymptomatic benign tumors • Repair (-rrhaphy
such as
enterorrhaphy)
• Surgical – outright surgical
• Non-surgical – non-surgical at all times (no operation)
• Potentially surgical – surgical only when needed
Fundamentals and • Basic treatment modalities for RUQ abdominal
Generalities in pain?
Medical
Management of Examples of OUTRIGHT NON-SURGICAL
RUQ ABDOMINAL ABDOMEN
PAIN and • Viral hepatitis
GALLBLADDER • Cirrhosis Non-Surgical Treatment:
Disorders • Urinary tract infection • Medicines
• NO medicines (watchful waiting;
natural support management; etc.)
• Surgical – outright surgical
• Non-surgical – non-surgical at all times (no operation)
• Potentially surgical – surgical only when needed
Fundamentals and • Basic treatment modalities for RUQ abdominal
Generalities in pain?
Medical
Management of BRCA Process in selecting cost-effective treatment
RUQ ABDOMINAL
modality.
PAIN and
GALLBLADDER
Disorders
Fundamentals and • Management of GALLBLADDER DISORDERS
Generalities in
Medical
Management of
RUQ ABDOMINAL
PAIN and
GALLBLADDER
Disorders
Fundamentals and • Management of GALLBLADDER DISORDERS
Generalities in
Medical Gallbladder disorders are common that all
Management of laypeople should be aware of them;
RUQ ABDOMINAL recognize them; know what to do; and be
PAIN and
GALLBLADDER knowledgeable of how physicians manage
Disorders them.
(A PATIENT EMPOWERMENT PROGRAM)
Fundamentals and • Management of GALLBLADDER DISORDERS
Generalities in
Medical Gallbladder
Management of • part of digestive system
RUQ ABDOMINAL • main function is to store bile from liver
PAIN and • bile helps break down fats
GALLBLADDER • bile is a mixture of mainly cholesterol, bilirubin
Disorders
and bile salts

Can one live without a gallbladder? YES

Fundamentals and • Management of GALLBLADDER DISORDERS
Generalities in
Medical Gallbladder disorders / diseases:
Management of
RUQ ABDOMINAL • Acute cholecystitis (inflammation of the
PAIN and
GALLBLADDER gallbladder) usually associated with
Disorders gallbladder stones (very common)
• Gallbladder polyps
• Gallbladder cancer (rare)
 Among the gallbladder
Fundamentals and • Management of GALLBLADDER DISORDERS disorders, reasons why
Generalities in gallbladder stone with
Medical In all patients with RUQ abdominal pain,
inflammation is considered.
Management of CHOLECYSTITIS WITH GALLSTONE is always a • Gallbladder polyps –
RUQ ABDOMINAL possibility and should be considered in the usually asymptomatic
PAIN and evaluation (with gallbladder stone being a • Gallbladder cancers –
GALLBLADDER common cause of cholecystitis). usually asymptomatic –
Disorders developing symptoms
only when with big size
However, NOT all RUQ abdominal pains are due and advanced
to cholecystitis and gallbladder stones. Other • Gallstone with
diagnoses should be considered such as diseases cholecystitis are usually
of the liver and pancreas and other organs in the painful.
• Gallstone without
area and also, the so-called nonspecific medical
cholecystitis –usually NO
conditions. pain.
Fundamentals and • Management of GALLBLADDER DISORDERS
Generalities in
Medical Clinical Diagnosis of Acute Cholecystitis (usually
Management of caused by gallstones)
RUQ ABDOMINAL
PAIN and
GALLBLADDER
Disorders
Fundamentals and • Management of GALLBLADDER DISORDERS
Generalities in
Medical Clinical Diagnosis of Acute Cholecystitis (usually
Management of caused by gallstones)
RUQ ABDOMINAL Presence of definite, persistent, progressive pain
PAIN and and tenderness on the RUQ abdomen at the area
GALLBLADDER of the GALLBLADDER
Disorders
Fundamentals and • Management of GALLBLADDER DISORDERS
Generalities in
Medical Clinical Diagnosis of Acute Cholecystitis (usually
Management of caused by gallstones)
RUQ ABDOMINAL
PAIN and
GALLBLADDER
Disorders
Fundamentals and • Management of GALLBLADDER DISORDERS Gallstone as a cause
Generalities in of the acute
Medical Clinical Diagnosis of Acute Cholecystitis (usually
cholecystitis is
Management of caused by gallstones)
primarily suspected
RUQ ABDOMINAL Suspect gallbladder disorder after suspecting
only because it is a
PAIN and acute cholecystitis.
GALLBLADDER very common cause.
Disorders The foremost cue for the clinical diagnosis of a
Gallbladder polyps
gallbladder disorder is the presence of symptoms
and cancer are usually
and signs of ACUTE CHOLECYSTITIS.
asymptomatic and
diagnosed only on
Reliable sign: Presence of definite, persistent,
ultrasound and other
progressive pain and tenderness on the RUQ
imaging procedures.
abdomen at the area of the GALLBLADDER.
Fundamentals and • Management of GALLBLADDER DISORDERS
Generalities in
Medical Paraclinical Diagnostic Procedures for Gallbladder
Management of Disorders
RUQ ABDOMINAL Options:
PAIN and • Ultrasound
GALLBLADDER • CT scan
Disorders • MRI

Most cost-effective is ultrasound – first choice

CT scan and MRI are done only if there are
questions on ultrasound.
MRI better than CT scan in terms of info yield
Fundamentals and • Management of GALLBLADDER DISORDERS
Generalities in
Medical Paraclinical Diagnostic Procedures for Gallbladder
Management of Disorders
RUQ ABDOMINAL • Ultrasound
PAIN and
GALLBLADDER
Disorders
Fundamentals and • Management of GALLBLADDER DISORDERS
Generalities in
Medical Paraclinical Diagnostic Procedures for Gallbladder
Management of Disorders
RUQ ABDOMINAL • Ultrasound
PAIN and
GALLBLADDER
Disorders
Stones

Polyps
Fundamentals and • Management of GALLBLADDER DISORDERS
Generalities in
Medical Paraclinical Diagnostic Procedures for Gallbladder
Management of Disorders
RUQ ABDOMINAL • Ultrasound
PAIN and
GALLBLADDER
Disorders
Fundamentals and • Management of GALLBLADDER DISORDERS
Generalities in
Medical Paraclinical Diagnostic Procedures for Gallbladder
Management of Disorders
RUQ ABDOMINAL • Ultrasound
PAIN and
GALLBLADDER
Disorders GB Cancer

GB Polyps
Fundamentals and • Management of GALLBLADDER DISORDERS
Generalities in
Medical Management of GALLBLADDER POLYPS
Management of
RUQ ABDOMINAL Polyps are usually incidental findings on
PAIN and ultrasound and other imaging procedures.
GALLBLADDER They are usually asymptomatic. 95% to 99% are
Disorders NOT CANCER.
• If polyps are less than 1 cm, multiple,
pedunculated (not sessile), NO SURGERY
(cholecystectomy) is needed. Just
surveillance.
• If polyps are suspicious for cancer, SURGERY is
indicated.
Fundamentals and • Management of GALLBLADDER DISORDERS
Generalities in
Medical Management of GALLBLADDER POLYPS
Management of
RUQ ABDOMINAL
PAIN and
GALLBLADDER
Disorders

Cholesterol deposits – pseudopolyps

Fundamentals and • Management of GALLBLADDER DISORDERS
Generalities in
Medical Management of GALLBLADDER CANCER
Management of
RUQ ABDOMINAL • If polyps are suspicious for gallbladder cancer,
PAIN and SURGERY (cholecystectomy) is indicated.
GALLBLADDER • If gallbladder cancer is detected and still
Disorders operable, SURGERY is indicated. If not, just
palliative and hospice care.
Fundamentals and • Management of GALLBLADDER DISORDERS
Generalities in
Medical Management of GALLBLADDER STONES
Management of
RUQ ABDOMINAL
PAIN and
GALLBLADDER
Disorders
Fundamentals and • Management of GALLBLADDER DISORDERS
Generalities in
Medical Management of GALLBLADDER STONES
Management of
RUQ ABDOMINAL GB stones may be asymptomatic or symptomatic.
PAIN and
GALLBLADDER Asymptomatic GB stones are incidental findings
Disorders on ultrasound and other imaging procedures. The
GB stones are not causing abdominal pain or
distress.

Symptomatic GB stones are those that are causing

abdominal pain and other side effects like
jaundice.
Fundamentals and • Management of GALLBLADDER DISORDERS
Generalities in
Medical Management of GALLBLADDER STONES
Management of
RUQ ABDOMINAL For ASYMPTOMATIC GB stones, regardless of
PAIN and number and size, watch and wait can be done.
GALLBLADDER
Disorders After the first onset of symptoms, RUQ
abdominal pain, SURGERY (cholecystectomy –
removal of gallbladder with the contained stones)
is recommended.
Fundamentals and • Management of GALLBLADDER DISORDERS
Generalities in
Medical Management of GALLBLADDER STONES
Management of
RUQ ABDOMINAL For SYMPTOMATIC GB stones, removal of
PAIN and gallbladder with the contained stones is
GALLBLADDER recommended.
Disorders
There are no more cost-effective treatment
procedures aside from SURGERY.
Medicine and the so-called “apple flushing” are
NOT effective, NOT cost-effective.
Fundamentals and • Management of GALLBLADDER DISORDERS
Generalities in
Medical Management of GALLBLADDER STONES
Management of
RUQ ABDOMINAL In surgery for gallbladder stones, the whole
PAIN and gallbladder with the contained stones are
GALLBLADDER removed. NO just the stones!
Disorders
- as there will be a significant risk of recurrence
of stones if the gallbladder is left behind.
Besides, losing a gallbladder is not a risk factor
for a shortened lifespan.
- One can live without a gallbladder!
Fundamentals and • Management of GALLBLADDER DISORDERS
Generalities in
Medical Management of GALLBLADDER STONES
Management of
RUQ ABDOMINAL In cholecystectomy or surgery for gallbladder
PAIN and removal, there are currently two general
GALLBLADDER methods:
Disorders • Conventional open cholecystectomy*
• Minimally invasive cholecystectomy

*Open mini-lap cholecystectomy

Fundamentals and • Management of GALLBLADDER DISORDERS
Generalities in
Medical Types of Cholecystectomy
Management of
RUQ ABDOMINAL
PAIN and
GALLBLADDER
Disorders
Fundamentals and • Management of GALLBLADDER DISORDERS
Generalities in Procedures Benefit Risk Cost Availability
Medical Option1 • Very Higher  Most  Some
Management of small complication expensive centers –
incisions rate because of not readily
RUQ ABDOMINAL • Less pain (particularly special available
PAIN and • Early bile duct instruments
GALLBLADDER return to injury)
work
Disorders
Option2 Shorter      Readily
operating available
time
Option3 Shorter      Readily
operating available
time

Option1: Lapchole; Option2: Minilap Chole: Option 3: Longlap chole

Fundamentals and Summary
Generalities in
Contents of RUQ ABDOMINAL PAIN
Medical and GALLBLADDER Disorders Take Away
Management of • What is a RUQ abdominal pain?
RUQ ABDOMINAL • What are the different types of RUQ abdominal
PAIN and pain?
GALLBLADDER • What are the causes of RUQ abdominal pain?
Disorders • How common are RUQ abdominal pain?
• Clinical diagnosis of RUQ abdominal pain?
• Paraclinical diagnostic procedures for RUQ
abdominal pain?
• Basic treatment modalities for RUQ abdominal
pain?
• Management of GALLBLADDER DISORDERS
Fundamentals and Be always in touch with reliable medical
Generalities in Take Away in
information on fundamentals and
Medical relation to
Management of generalities in medical management of
Patient
RUQ ABDOMINAL RUQ ABDOMINAL PAIN and GALLBLADDER
Empowerment
PAIN and DISORDERS.
GALLBLADDER
Knowledge is power; it gives power.
Disorders
Use the 4Ks of Patient Empowerment:
Kaalaman, Kakayanan, Karapatan and
Kapangyarihan
to gain greater control over decisions in
medical management of RUQ ABDOMINAL
PAIN and GALLBLADDER DISORDERS.
Health Disorder Empowerment May 14, 2022
Course– objective - for 1400H - 1500H
Fundamentals laypeople to have an Via Zoom
and understanding of the
Generalities in FUNDAMENTALS and
Medical GENERALITIES in
Management MEDICAL
of RUQ MANAGEMENT of
ABDOMINAL RUQ ABDOMINAL
PAIN and PAIN and
GALLBLADDER GALLBLADDER
RUQ – Right Upper Quadrant
Disorders DISORDERS.