real case, rt abd pain and shoulder pain - joya

[ArchivalUser]

Dear all,
I need your advise about a pt. She has rt upper abdominal pain(below the rib) and rt shoulder pain. Pain is worse at mid night. All her blood work, LFT,U/A, USG of whole abdomen, endoscopy, ECG, Echocardiography came back normal. Serum amylase, lipase also normal.
PMH : pt has pacemaker, stent, osteoarthritis
PSH: cholecystectomy in 2008

Pt is not diabetic,
Med: Aspirin, Lipitor, Multivitamin

Pain arise at same time midnight. no relation with movement. She hardly can sleep at night.

What could the possible diagnosis? And is there any more test to do?

I appreciate your advise.
Thanks.

[ArchivalUser]

sdadf

[ArchivalUser]

DD:
1- post cholecystectomy syndrome.... the first on the list...long cystic duct stump giving the exact symptoms
MRCP will not fit because the pacemaker..ERCP despite more invasive will be the better choice (noraml US alone can not rule subdiaphragmatic old collected blood causing traction contraction on the diaphragm)

how old is the patient, what was the reason for the cholcystectomy? any other medical conditions?
CTabdomen with oral and IV contrast

lastly.. musckluskeletal cause....how is the ROm of both shoulders? Xray and ESR, R out frozen shoulder(3 phases dont get tricked
liptor can give skeletal side effects...cpk level

[ArchivalUser]

joya Do you have any other cases???

[ArchivalUser]

RT Shoulder pain means diaphragm is irritated....probably rupture of viscus


pt is on aspirin..may hv peptic ulcer perforation...do AXR/ct scan ....look for free air under diaphragm...

[ArchivalUser]

pt already hv cholecystectomy so GB cant b etiology...

[ArchivalUser]

could be GERD.

[ArchivalUser]

h. pylori is negative?

[ArchivalUser]

Joya , will appreciate your feedback on this patient. hope she does well
Thx

[ArchivalUser]

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