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Present Illness:   This 70 y/o female reported G-bladder stone s/p cholecyctomy few years ago. patient didn’t take regular medication except for some painkiller for right hip pain.   She complaint epigastralgia since yesterday morning before lunch. Patient described it’s a twitching pain and it... 顯示更多 Present Illness:
  This 70 y/o female reported G-bladder stone s/p cholecyctomy few years ago. patient didn’t take regular medication except for some painkiller for right hip pain.

  She complaint epigastralgia since yesterday morning before lunch. Patient described it’s a twitching pain and it radiated to lower abdomen, back but on chest discomfort and did not radiate to left arm or jaw. She mentioned no specific releasing factors and did not relate to posture. Besides, patient reported fever and poor appetite yesterday afternoon.

  Patient reported no nausea, vomiting,diarrhed recently. She also denied cough or sputum product, no cramping pain or constipation. There’s no liver disease history or large meal intake.

  She went to our ER last night, vial sing:38.4/112/18 BP:120/78. CXR was clear, and lab data revealed WBC 14.4 with left shifting, Plt 76, PT prolong 15.2, CRP 168.6. Abdominal echo was arranged: Mild dilated CBD/IHDs and pneumobilia, splenomegaly, with chronic liver parenchymal disease. CT was performed and it revealed ascites, biliary dilation with pneumobilia. (Patient was admitted to our ward for further …………)
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