Nama saw a 55yo female who presented with CP. She was treated with aspirin and GTN by MAS. Her obs were stable and she looked well. She had undergone a stress MIBI 2 years previously: NAD.
On examination, she had no murmurs, a clear chest and normal ECG.
However, she had RUQ tenderness and a positive Murphey's sign.
Does she have cardiac CP or biliary colic?
trop came back normal.
but so did WCC and CRP <2
But this is why we have US.
Nama did a beautiful GB US
Benign looking GB with hyper echoic stone and shadowing
Another view of the GB shows a stone in the GB neck and pericholecystic fluid.
The patient was fasted and admitted under EGS. She had a cholecystectomy for acute cholecystitis the next day.
The presence of gall stones and a positive sonographic Murphey's are two of the key features to look for with suspected acute cholecystitis in ED.
Other supportive features are
1. dilated GB >5cm (trans) >10cm (long)
2. thickened GB wall >4mm, fluid in GB wall, gas in GB wall
3. pericholecystic fluid
4. dilated CBD >6mm (with this need to consider ascending cholangitis).