Mr Tapping Case Study

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Chief Complaint/ Present illness: Mr. Tapping is a 32-year-old obese African-American male who visited the hospital with a chief complaint of postprandial gastralgia. The patient was well two weeks ago when he noticed the gradual onset of intermittent epigastric pain, after eating. Initially each episode lasted for ½ hour, was mild, and located diffusely in the upper abdomen. Over time the episodes lengthened to 1-2 hours, became severe, and localized in the RUQ. As of yesterday, he has vomited three times, and is now anorexic. The patient denies any previous history of abdominal pain, hemorrhoids, recent weight gain or loss, illicit drug use and excessive alcohol consumption. There are no suggestions of prior postprandial symptoms, or jaundice.…show more content…
Vitals: BP 173/80; Temp 98.5F; HR 97bpm; Skin: clear, no evidence of jaundice Lymphatics: unremarkable HEENT: Sclera was icteric, ears, nose, and throat are clear Chest: unremarkable Abdomen: Moderately obese with a very tender globular mass in the RUQ. No splenomegaly or hepatomegaly noted on palpation. Rebound tenderness was negative over the RLQ. No ascites noted, or other evidence or portal hypertension. Bowels sounds are normal and no bruits noted. Pelvic/Rectal: within normal limits, Guaiac negative, significant steatorrhea noted Extremities: All distal pulses are palpable, no edema noted Lab tests: Blood: Within normal limits except for hypercholesterolemia, and hypebilirubinemia Urine: Bilirubin 3+ Echo scan gallbladder: Gallbladder is approximately 13 cm in length with four to five spherical calculi visualized each approximately 1.5 cm at their greatest diameter. Impression: Acute cholecystitis, from

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