Surgery Case

History

Amina Ahmed is 50-year-old woman was referred by the surgical outpatient clinic by her
general practitioner .She had been complaining of intermittent bouts of abdominal pain over
the preceding 6 months. When the pain occurred, it was constant, associated with nausea and
usually lasted for a couple of hours. She had also noticed that fried foods triggered the
attacks. In the referral letter, the GP also mentioned that her body mass index (BMI) was 38
but that she had been actively trying to lose weight. She has no past medical history.

Examination

On examination, the patient is afebrile with a pulse rate of 80/min. She has no evidence of
jaundice and no palpable lymphadenopathy. On palpation of her abdomen there is mild
tenderness in the right upper quadrant. Rectal examination is normal and urinalysis is clear.

The patient weight was 99 kg and hight 168 cm

Investigations

Ref. Range Result

Chemistry
Sodium (mEq/L) 136–145 137
Potassium (mEq/L) 3.5–5.1 3.7
Chloride (mEq/L) 98–107 101
Carbon dioxide (CO2, 23–29 24
mEq/L)
Bicarbonate (mEq/L) 23–28 24
BUN (mg/dL) 6–20 12
Creatinine serum (mg/dL) 0.6–1.1 F 0.7
0.9–1.3 M
BUN/Crea ratio 10.0–20.0 17
Uric acid (mg/dL) 2.8–8.8 F 9
4.0–9.0 M
Est GFR, non-Afr Amer > 60 103
(mL/min/1.73 m2 )
Glucose (mg/dL) 70–99 99
Phosphate, inorganic 2.2–4.6 3.2
(mg/dL)
Magnesium (mg/dL) 1.5–2.4 1.8
Calcium (mg/dL) 8.6–10.2 9.1
Osmolality (mmol/kg/H 2 O) 275–295 286
Bilirubin total (mg/dL) ≤ 1.2 0.7
Bilirubin, direct (mg/dL) < 0.3 0.1
Protein, total (g/dL) 6–7.8 5.8
Albumin (g/dL) 3.5–5.5 2.9
Prealbumin (mg/dL) 18–35 17
Ammonia (NH3 , µg/L) 6–47 8
 Alkaline phosphatase (U/L) 30–120 45
ALT (U/L) 4–36 17
AST (U/L) 0–35 11
CPK (U/L) 30–135 F 121
55–170 M
C-reactive protein (mg/dL) < 1.0 1.3 !
Lactate dehydrogenase 208–378 210
(U/L)
Cholesterol (mg/dL) < 200 235 !
HDL-C (mg/dL) > 59 F, > 50 M 64
VLDL (mg/dL) 7–32 22
LDL (mg/dL) < 130 149 !
LDL/HDL ratio < 3.22 F 2.33
< 3.55 M
Triglycerides (mg/dL) 35–135 F 139 !
40–160 M
T4 (µg/dL) 5–12 7.2
T3 (µg/dL) 75–98 81
HbA1C (%) <5.7 6.5 !
Coagulation (Coag)
PT (sec) 11–13 12.1
PTT (sec) 24–34 27
Hematology
WBC (x 10 3/mm 3) 3.9–10.7 8.5
RBC (x 10 6/mm 3) 4.2–5.4 F 4.4
4.5–6.2 M
Hemoglobin (Hgb, g/dL) 12–16 F 11.5 !
14–17 M
Hematocrit (Hct, %) 37–47 F 36 !
41–51 M
Platelet count (x 10 3/mm 3 ) 150–350 273

Plan
The history suggests a diagnosis of chronic cholecystitis. An ultrasound of the abdomen
should be requested, which may reveal gallstones situated within a thick walled gallbladder

Initially, patients are advised to avoid high-fat meals,

Laparoscopic cholecystectomy should be done to patients .