Biliary colic results in pain arising from gallstones impinging on the walls of the biliary tract or the gallbladder sphincter. Biliary colic is painful and affects breathing. There is severe vomiting on an empty stomach as patient cannot consume any food. Vomitus is clear white or clear yellowish. There is no change in bowel habit (BO) or passing urine (PU). There is no associated fever but there is profused sweating and patient feels cold. A patient with biliary colic ends up in the A&E in the wee hours of the morning.
A&E Admisison
The patient is brought to A&E in a wheelchair early in the morning at 7 am. Breathing is laboured. Patient is in great pain, very tired and eyes closed.
A&E Investigations
BP is checked and is high 190/113.
Blood is taken from a butterfly IV line and sent to A&E Lab for analysis
BUSE, cardiac enzymes - normal.
Serum amylase was not done
Since patient is in severe pain, morphine IV is administered in 4 doses.
Once patient is not affected by excrutiating pain, questions can be asked.
ECG was done since heart problem was suspected
ECG was normal
A&E Questions Asked
Source of pain and from where it arise: lumbar, upper right epigastric region
Spread of pain: from right back shoulder, to right side, to under right breast
Intense pain won't go away before morphine administration
Pain is reduced after morphine injection and becomes bearable
Medical History
Two small gallbladder stones were detected 3 years ago, not followed up
This is the first eipsode in 3 years after first diagnosis
Patient was advised to go for gallbladder surgery but patient was unwilling (willing to wait)
Now the intense pain makes surgery the only option
Ultrasound Investigation
One gallbladder stone (2cmx1cm) was detected, not 2 stones
This time the stone is big and needs to be removed
Appointment for ultrasound 10 July 2013
Gallbladder surgery scheduled for after 20 August 2013; next available slot is 28 September 2013
Prescriptions
For the time being, while waiting for ultrasound and gallbladder surgery, these drugs were prescribed:
1. Amlodipine Besylate 10mg
2. Tramadol HCl 50mg
3. Metoclopramide 10mg
4. Celecoxib 200mg
Patient is discharged from A&E Day Ward at 3 pm.
External links:
http://www.healthline.com/health/gallstones#Overview1
Gallbladder pain - How to know if what you are feeling is gallbladder pain
https://youtu.be/ez14kQOx7is
A&E Admisison
The patient is brought to A&E in a wheelchair early in the morning at 7 am. Breathing is laboured. Patient is in great pain, very tired and eyes closed.
A&E Investigations
BP is checked and is high 190/113.
Blood is taken from a butterfly IV line and sent to A&E Lab for analysis
BUSE, cardiac enzymes - normal.
Serum amylase was not done
Since patient is in severe pain, morphine IV is administered in 4 doses.
Once patient is not affected by excrutiating pain, questions can be asked.
ECG was done since heart problem was suspected
ECG was normal
A&E Questions Asked
Source of pain and from where it arise: lumbar, upper right epigastric region
Spread of pain: from right back shoulder, to right side, to under right breast
Intense pain won't go away before morphine administration
Pain is reduced after morphine injection and becomes bearable
Medical History
Two small gallbladder stones were detected 3 years ago, not followed up
This is the first eipsode in 3 years after first diagnosis
Patient was advised to go for gallbladder surgery but patient was unwilling (willing to wait)
Now the intense pain makes surgery the only option
Ultrasound Investigation
One gallbladder stone (2cmx1cm) was detected, not 2 stones
This time the stone is big and needs to be removed
Appointment for ultrasound 10 July 2013
Gallbladder surgery scheduled for after 20 August 2013; next available slot is 28 September 2013
Prescriptions
For the time being, while waiting for ultrasound and gallbladder surgery, these drugs were prescribed:
1. Amlodipine Besylate 10mg
2. Tramadol HCl 50mg
3. Metoclopramide 10mg
4. Celecoxib 200mg
Patient is discharged from A&E Day Ward at 3 pm.
External links:
http://www.healthline.com/health/gallstones#Overview1
Gallbladder pain - How to know if what you are feeling is gallbladder pain
https://youtu.be/ez14kQOx7is
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