2. Case 1
• Female patient , 40 yrs, married with 2
children
• Presented with acute upper rt quadrant pain
referred to the back and rt shoulder, and fever.
• On examination the ebdomen was markedly
tender but no rigidity
4. Treatment
1. Medical only
2. Surgical immediately
3. Antibiotics then surgery
4. Medical and surgery in case of recurrence
5. Bile acid therapy
• Small stone size (<0.5 to 1 cm)
• Mild symptoms
• Good gallbladder function (ie, normal filling
and emptying)
• Minimal calcification and low density on
computed tomographic (CT) imaging
6. Case 2
• Female patient, 53yrs,
• Presented with vague upper abdominal
discomfort, dyspepsia, nausea and occasional
vomiting.
• Clinical examination was unremarkable
9. Case 3
• Female patient, 67 yrs
• Presented with jaundice, dyspepsia and loss of
weight
• CA 19-9 was significantly raised
• MRCP showed a hilar mass
• ERCP confirmed
• Management?
10.
11.
12. Case 4
• Female patient 41, presented with acute
upper abdominal pain referred to the back
• Clinically the abdomen was very tender but
not rigid
• Ultrasound showed calcular cholecystitis with
few CBD stones and dilatation.
• What next?
13. • Diagnosis of acute gall stone pancreatitis
pancreatitis was established…
• What next?