IVANO FRANKIVSK

NATIONAL MEDICAL
UNIVERSITY 

DEPARTMENT OF INTERNAL
MEDICINE
ELIJAH HARAZI
59D+
PASSPORT DATA
 Name: Harry Styles
 Age:28
 Sex: Female
 Marital Status: Married
 Occupation: Musician
COMPLAINT
pain is typically epigastric, often radiates to the back, is occasionally associated with
nausea and vomiting, and may be relieved by sitting upright or leaning forward. The pain
is often worse 15 to 30 minutes after eating. The pain occurs in discrete attacks; as the
condition progresses, the pain tends to become more continuous. Patient also has fever
.chills.nausea.vomiting.loose, light-colored stools.itching.Tenderness over your abdomen
when it's touched. Pain often occur after a meal, particularly a large or fatty one.
PRELIMINARY DIAGNOSIS
 The complete blood count, electrolytes, and liver function tests are typically normal.
Elevations of serum bilirubin and alkaline phosphatase suggest compression of the
intrapancreatic portion of the bile duct by edema, fibrosis, or pancreatic cancer.
Confirmation of increased fecal fat excretion may be sufficient to diagnose chronic
pancreatitis. Fecal elastase measurement is the most sensitive and specific, especially
in the early phases 
LAB TESTS AND
FINAL DIAGNOSIS
  CT, MRI, and US — Transabdominal ultrasonography (US), CT scan,
and MRI may show calcifications, ductal dilatation, enlargement of
the pancreas, and fluid collections (eg, pseudocysts) adjacent to
the gland . The sensitivity and specificity of ultrasound for the
diagnosis of chronic pancreatitis are 60 to 70 percent and 80 to 90
percent, respectively. The corresponding values for CT scanning
are 75 to 90 and 85 percent, respectively.Endoscopic ultrasonography
may be as sensitive as ERCP or pancreatic function testing The most
predictive endosonographic feature is the presence of stones.Given the overlapping
findings between acute and chronic cholecystitis, sometimes ultrasound and CT may
be adequate to come to a final diagnosis. A magnetic resonance imaging (MRI)
study is a useful alternative in patients who are unable to undergo a CT scan due to
radiation concerns or renal injury.The diagnostic test of choice to confirm chronic
cholecystitis is the hepatobiliary scintigraphy or a HIDA scan with
cholecystokinin(CCK)
DIFFERENTIAL DIAGNOSIS
 The above diagnostic studies are frequently supportive but not necessarily diagnostic of chronic pancreatitis.
 Pancreatic cancer is the primary diagnosis that must be considered in patients suspected of having chronic
pancreatitis. There are some data to suggest that chronic pancreatitis is associated with an increased risk of
developing pancreatic carcinoma.
 Patients with pancreatic cancer often present with epigastric pain similar to that seen with chronic
pancreatitis. Other overlapping findings include weight loss and jaundice. Findings suggestive of possible
pancreatic cancer in a patient thought or known to have chronic pancreatitis include older age, absence of a
history of alcohol use, weight loss, a protracted flare of symptoms, and the onset of significant constitutional
symptoms. Other diagnoses to consider in patients with chronic abdominal pain include peptic ulcer disease,
gallstones, and irritable bowel syndrome. Acute pancreatitis may also be difficult to distinguish from chronic
pancreatitis in some patients.
TREATMENT
 The preferred treatment for chronic cholecystitis is elective laparoscopic cholecystectomy. It
has a low morbidity rate and can be performed as an outpatient surgery. An open
cholecystectomy is also an option however requires hospital admission and longer recovery
time. This surgery is indicated in patients who are not laparoscopic candidates such as those
with extensive prior surgeries and adhesions. Endoscopic retrograde
cholangiopancreatography (ERCP) is usually done when choledocholithiasis is a concern.
These patients usually undergo ERCP prior to elective surgery. 

 Patients who are not surgical candidates or who prefer not to undergo surgery can be closely
observed and managed conservatively. A low-fat diet can help reduce the frequency of
symptoms. In patients with symptomatic cholelithiasis, the use of ursodeoxycholic acid
(UDCA or ursodiol) has been shown to decrease rates of biliary colic and acute
cholecystitis.However, the literature on its role in chronic cholecystitis is limited. The
management of asymptomatic patients with incidentally detected chronic cholecystitis
depends on patient characteristics. Asymptomatic patients with no radiological or clinical
concerns of malignancy can also be closely monitored with follow-up imaging. 
PROGNOSIS
 The majority of uncomplicated cases of cholecystitis have an excellent outcome. In
many cases, supportive treatments can help with symptoms. Most cases are treated
with elective cholecystectomy to prevent future complications. While surgery is safe,
bile duct injuries can happen and need to be monitored in the post-operative period.