Cholangitis

You work as a resident in emergency room. Lately at night a female patient (48 y.o.) arrives. She is tired, exhausted and complains of the pain in her upper abdomen. She has fever of 38 degrees and adds that has vomited repeatedly in the last 2 days, she negates any diet mistake. You do a complete history and physical examination. What is your next step?

Due to the fever, dyspnea and pain, we prescribe ATB to the patient, send her home and recommend to visit a general practitioner the next day.

We collect a blood sample for laboratory examination and record the ECG, perform an X-ray of the abdomen and thorax, eventually take patients urine for biochemistry and sediment examination.

We collect a blood sample for laboratory examination and record an ECG, perform a chest X-ray and prepare a complete internal preoperative examination for diagnostic laparoscopy according to possible acute abdomen.

years

woman

26 /min

110 /min

SpO2

95 %

100/60 (73) mmHg

Examination

Medical history:
Family history: insignificant
Past medical history: without chronic diseases, st.p. appendectomy in 1998
Gynaecological: regular menstruation, without problems, 2 children
Medications: negates
Allergies: pollen, bees
Habbits and abusus: smokes (approx. 1 box per week), alcohol occasionally, 2 cups of coffee a day
Physiological functions: stool and urination without any problems. Stabile weight.
Physical examination:
Conscious, orientated patient, neurological status without any remarkabilities. Febrile 38.5 °C with chills, icteric. Head and neck: sclera icteric, other without any pathologies. Lungs and heart: tachypnoea, alveolar breathing bilaterally symmetrical, without pathological phenomena, regular heart action, heart sounds normal, without murmur. Abdomen: stiff, difficult to palpate and examine for pain in the right upper part. Peristalsis audible. Scar in the right lower hypogastric region. Extremities: without swelling or sign of inflammation.

Glycaemia

Take a sample