Cholecystitis Puns

Perspective of an ER pharmacist

I received a phone call regarding antibiotic selection in the setting of multiple allergies for a patient diagnosed with cholecystitis by ER PA.

I discuss with the patient their allergies and subsequent reactions (hives to cephalosporins). I noted prior to approaching the patient that they were positive for oxycodone on UDS and asked what other medications they had been taking.

As I entered the room, I noted severe jaundice of the eyes.

Patient stated they had taken an old Percocet for the pain and had been taking APAP “every 4 hours or so” but could not describe how much.

I looked up their labs and noted Tbili 9.5, ALT/AST 10x ULN. No INR resulted. Imaging stated “probable cholelithiasis”.

Hospitalist had already seen patient so after abx recommendation, I asked if he had any concern for masked/concomitant APAP toxicity.

Hospitalist agreed we could order an APAP level just to be certain but he was pretty sure this was all obstructive. I agreed this is a classic obstruction presentation and was really just wondering if he wanted a CYA APAP level. I could tell he didn’t really want to order it so I pressed and we decided just to nix the level. I was satisfied with this knowing the physician had it on his radar.

All that to ask: would any other physicians here have wanted to check just to be sure? I know a lot of thought goes into ordering levels that we (pharmacists) would deem mundane, but I’ve been on rounds and seen the thought process play out as to whether or not a level is even worth ordering.

If a diagnosis is fairly “slam dunk”, do you sometimes feel as though you need to still rule out plausible concomitant condition that would mimic or augment the diagnosis? I’m attempting to refine any recommendations for the future.

(22) (male) I had a lot of undiagnosed lower right back pain and eventually my doc recommended gallbladder surgery since I had sludge and some other symptoms that could indicate gallbladder problems. He told me on the follow up that I had chronic cholecystitis so I am just trying to understand the pathology report. What indications are there in the report that I had a badly inflamed gallbladder? Especially since I only had the pains for about 8 months I thought it was odd that the diagnosis was a chronically inflamed gallbladder. Thanks in advance!

Received in formalin and labeled "gallbladder" is a 9.8 x 3.0 cm intact gallbladder. The serosa is tan-pink to tan-blue, diffusely congested. The cystic duct is patent and measures 0.4 cm in diameter. Upon opening, there is a large amount of tan-green viscous bile and no choleliths. The mucosa is tan-green and velvety with no stippling. The gallbladder wall is pliable, measuring 0.2 cm in thickness. Representative sections are submitted in cassette 1A. AK/ka(N) Microscopic Description Unless 'gross-only' is specified, the final diagnosis for each specimen is based on a microscopic interpretation of the submitted sections of each tissue sample

Heya, 23F here. Kind of a long story, sry about that. My body's been a pain in the ass to deal with lately. Had a Crohn's suspicion due to weight loss, chronic diarrhea, lots of blood in stool, etc. Got a colonoscopy to figure it out, easy peasy. After the procedure, I walk out of the hospital with the results and it says I'm perfectly healthy, which should make me feel relieved but I still feel like shit (lol) so that does nothing for me.

At this point I'm ready to give up on searching wth is wrong with my insides and just deal with it as I go. But a few hours after getting home, I start to feel reaaaally sick. My main discomfort was fever/confusion and everything hurt. Fever didn't get much high (38°C/100°F) but I wasn't clear headed enough to think I needed to go to the hospital atm. In the morning the fever was mostly gone but I kept shivering and was completely exhausted so someone took me to an urgent care.

After 8h waiting while basically passed out in a chair, I got some blood tests done and my AST/ALT levels were high (like 200/300 each) along with a high white cell count and PCR. Doctor says it's best I stay in the hospital for a few days so they can watch me closely and also bc I had a fever and was still feeling some chills.

After one night sleeping in the corridor bc there was no room available, the chills basically disappeared and I was left with some mild, prior to severe, sweating. Two days later after my AST/ALT/PCR levels continued to get high, they started giving me antibiotics. All those days without taking a single shit and peeing a lot. I felt (and still feel) thirsty as hell. Also felt some mild pressure on my right side but other than that, I wasn't feeling what my exams were showing. So, because I felt so stellar (minus the constipation) as soon as my AST/ALT levels got a bit lower, I was sent home. The levels weren't (and still aren't) optimal, but I understand the hospital was full and needed the room for someone who was actually feeling terrible.

Sooooo, that was sunday. Tuesday night (yesterday) I started feeling the pressure on my right side getting more intense, along with some tingling/numbing feeling. It doesn't HURT per se but it doesn't feel right. If I reach the floor with my hands while standing up, the pain intensifies but it's not actually painful, just uncomfortable. I tried doing that rebound thing on my abdomen but it didn't feel like the pain was getting worse.

I am getting checked out by a doctor later but

Mmhm it true!

Thank goodness for Reddit. I went to the ER yesterday after being woke up at 4am with unbearable abdominal pain starting under my rib cage and in my upper back and shoulder blades. It felt like I was going into back labor. I took to Ibuprofen and by the time I was admitted I felt better just had a ton of bloating.

After blood tests and an ultrasound a suspected 2.5mm calcification was found in my distal common bile duct and my liver enzymes from my blood test were through the roof. The ER doctor didn't really explain anything other than I was headed towards having gallbladder disease and I need to see my dr to explore options preferably surgery.

I was absolutely stunned, other than having menstrual cramping and bloating I have had no prior stomach or GI issues. I don't have the healthiest diet but not the worst either. I drive on occasion usually on the weekends.

Has anyone else on here had a similar story? What did you decide on? Surgery or changing eating habits?

I am actually waiting to see my PCP for a follow up as we speak...

Thanks in advance!

I had my 2 week post op appointment with my surgeon this morning. My pathology report came back showing Chronic Acalculous Cholecystitis with Cholesterolosis. The only test that was conducted before the operation was an ultrasound and I was told that I had stones by my GI and surgeon, however they did not show up in the pathology report. I never got a HIDA test done since I was told numerous times to get my gallbladder removed because of stones AND it’s worth noting that I never experienced a gallbladder attack. My main symptoms were constant nausea, lack of appetite, subtle burning in my upper abdomen and weight loss (about 20lbs) from the lack of eating in the early weeks of being sick plus cleaning up my diet after finding out I had “stones”.

Has anyone else gotten a pathology report back with a similar diagnosis. I hope I did the right thing by removing my gallbladder and wasn’t misinformed. Clearly it was inflamed per the pathology report so it was obviously a problem. I just hope that surgery in hindsight was the way to go for this specific issue.

I seem to always get a question on this and haven’t picked out an identifying factor to come to an answer. Obviously like a McBurney’s point may give it away, but they specifically leave this out. She will have a fever and elevated white count and some R sided abd pain. What are the ways to separate this out and solve these common abd pain questions during pregnancy (that do not placenta, uterine, or vaginal bleeding related)?

Thanks everybody!

I have been experiencing pain from my upper mid abdomen to a few inches to the right, just below the ribs since yesterday. I had an intense attack last January at the same are but that one felt worse, like having a heart attack and felt at the back however it lasted 2am-9am not more than 24 hours like what I've been experiencing today. I had an ultrasound back then and got wall thickening of the gallbladder and polyps. Ever since then I've been having acid reflux and couldn't eat anything acidic, with tomatoes, garlic. Lost more than 20lbs in a month.

My doctor said it's probably not gallstone and it's gerd. My BMI is normal, early 30s, male. My omeprazole dosage was increased to 40mg. My globus and nausea disappeared but I still get heartburns and chest pain. I got referred to a gastroenterologist but my consulation won't be until May. Endoscopy would be weeks to months after that. 😞 I don't want to go to the ER right now because of the CCPvirus situation (we have around 70 cases in the city) plus they're just going to insist with the surgery without even ruling out other abdominal conditions. No HIDA scan, no endoscopy, just US.

Hoping to learn more from your experiences. Thank you.

UPDATE: Just got a call back from my primary doctor. She can't prescribe any medications for my pain now nor get a HIDA scan schedule because of the hospitals filled now. Just a refill again for my PPI. So I have no choice but to go to the ER if the pain won't go away. Sigh. Sometimes I find healthcare in the US very complicated. Thanks a lot for your comments, it's a huge learning experience and wishing you good health these days.

Been experiencing abdominal pain for 3 weeks and only figured out I had cholecystitis after 5 doctors. All the doctors before the 5th one thought it was IBS, UTI, Gastricitis, Appendicitis... 3 blood tests, 2 ultrasounds later.. 5th doc was the only one who was able to pinpoint what it was after applying pressure on all of the areas where my organs are located from my abdomen. And the one that hurt the most was my liver and gallbladder area. So she ordered yet another ultrasound. By this time the radiologist lady was really annoyed by me, trust me you could tell from her tone. She made me feel like I was just being dramatic or faking my pain? Seriously idk, whenever she put pressure on my abdomen and it was painful I would react a little and make sounds as reflex and she told me to tell her if its painful - and I thought it would help her find something... but she raised her voice and said “How can this be painful? I didn’t even do anything! How can I find anything if I stop everytime just because you feel pain when I’m not doing anything to you?” I’m like....... seriously lady do you think I’m playing games here?? I’m in pain!!! But I just kept quiet after saying “it hurts, but I never told you to stop. I’m just telling you”... and that was after 12hours of fasting so I was also lightheaded feeling like I was about to passout any minute. Lol sorry sidetracked. Anyway...

Final diagnosis was Cholecystitis and I got referred to surgery 2nd week of May... the doc is attempting treatment with antibiotics for now. I got 3 different kinds of painkillers (woohooo) and pills for bloating and gas, pills for constipation, pills for nausea and vomitting. I’m not sure what ‘kind’ of cholecystitis she means, but she said the radiologist (after telling me she can’t find anything wrong with me and hopes its the last time she sees me... it was like super sarcastic. It’s a really quiet little clinic so I know she wasn’t busy. I can’t get over it omg. It felt personal.)

Where was I? Lol. She found that I had a small obstruction at the neck of my gallbladder. And I don’t quite understand why that’s been causing me to have a high fever, no appetite, nausea, and abdominal pain in several different areas. Anyone have any ideas? Is it almost blocked therefore it became inflamed? Doc did say she worries that this problem can escalate pretty fast that’s why I have that appointment with the surgeon. But I still don’t fully get what’s going on and I’m scared lol. And sorry for th

A few years ago I started having abdominal pain and loose stools. Eventually the pain got worse, I couldn’t eat and could not stop vomiting. I was brought into the ER and was told it was either IBS or cyclical vomiting syndrome. As time passed I struggled to eat and began losing weight very quickly. I had a few instances of mild jaundice (yellow eyes) and started developing panic attacks and intense abdominal pain. I started getting sharp attacks on my right side and my gi doctor didn’t believe me when I suggested it could be my gallbladder because there were no stones but they did a HIDA scan anyways and it came back at 16% and was noted suspected Chronic Cholecystitis or Biliary Dyskinesia.

Multiple stool tests have shows fat malabsorption with no explanation, I’ve had two colonoscopies and 4 endoscopes.

I have a constant burning pain in the center of my chest just below the rib cage. It doesn’t let up. Surgeon says take it out, doctor says leave it. There’s a ton of urgency when going to the bathroom. The doctor says gallbladder problems don’t cause diarrhea but I’m at a total loss.

I have Gilbert’s which I know makes me more likely to have bilirubin stones.

Has anyone else had anything similar to this?

24/female/5ft/116lbs/caucasian

I've been having a horrible pain in my right side, under my ribs that wraps around to my bank, radiates to my left side and radiates to my legs. I've gone to the hospital the first day, in tears and probably at a 9/10 for pain. They gave me a ct scan that I don't have the results of but they didn't see anything in it. The pain comes with no matter what i eat, even if i don't eat it is there. Nothing has made it better other than sleep or letting it go away on its own which sucks.

Fast forward a month where I've been to the doctor at least twice and called multiple times and they finally gave me an ultrasound for my upper right quadrant of my stomach. Ultrasound results: https://imgur.com/a/N1GSK

They decided to also give me a HIDA scan, based on them being certain it was my gallbladder that is causing me pain. The results are chronic cholecystitis and at this point I've been in pain for 3 months, at least 4 days a week during this time. At least 3 times where I'm on the floor crying in pain. HIDA scan results: https://imgur.com/a/Z6I8g

They're telling me to go on a low fat diet which is what I've been working on doing and told me to do that for 2 more months. The fact that I have the pain no matter what, I'm not sure if they listen to the fact that I'm still in pain all the time. I'm really not excited about 5 months total in pain but is this all standard for chronic cholecystitis? My doctors haven't been so great and I've been thinking of leaving them but wanted to stay at one place during all the tests for my gallbladder. Any other tips for my chronic cholecystitis to help me not be in pain almost daily?

According to OME and Medbullets it looks like the second test you would get after a negative ultrasound with suspicion of cholecystitis is a HIDA, while the second test you would get after a negative ultrasound with suspicion of cholelithiasis, choledocholithiasis, or cholangitis is MRCP. Why is cholecystitis the odd one out of the bunch? Is there a reason why MRCP wouldn't be a good second-line test? (I would have imagined that the soft tissue visualization would be useful?)

If only someone had told me this earlier I wouldn't have spent 7 years getting bounced from doctor to doctor who wouldn't test for it because I was "too young".

Have terrible pain in right upper quadrant that radiates to back. Had for years and getting worse. Nausea, loose oily yellowish stools, fatigue, pain after eating certain foods (fatty meat, nuts, cheese etc). Had all the tests and consulted all the experts and nothing appears abnormal. I know certain conditions like Pancreatitis, Cholecystitis and Biliary Dyskinesia can on occasions be difficult to diagnose and Im pretty sure its Pancreatitis or Cholecystitis. Look fit, trim, healthy and eat really well. Dont drink or smoke or take drugs. I dont get bloating or diarrhoea and pancreatic/digestive enzymes are normal in blood and CDSA stool tests.

Any ideas?

Gallbladder ultrasound showed 2 gallstones with the largest 1.5cm but not blocking any ducts. HIDA scan showed 7.3% ejection fraction and report said that findings are suggestive of either chronic cholecystitis or biliary dyskinesia.

I have episodes of very severe pain, periods of feeling ok, and periods of mild pain. I'm often nauseous, occasionally dizzy, extremely fatigued and just feel generally unwell to the point that it is interfering with my life severely.

I have an appointment with a surgeon on Wednesday, but I have to confirm a May vacation tonight and I'm a little hesitant without having any information.

Any idea what the surgeon will say? Is this the kind of surgery that they will get to quickly or will I have to wait a long time to have it?

Any other thoughts or comments about what I've shared? Any info is helpful.