Case 1: My Mom's sick.

MBBS
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A women in his mid 20s walked with her mother, pale, tired and disturbed walked into the doctors cabin. As she sat, she was restless and groaned in pain. Upon asking her daughter revealed, she has pain in stomach after the breakfast which includes ghee paratha and some tea. Also she throws the food out once she’s done eating.
After asking the patient, she says it hurts her below the breast and is in episodes but it got worse in last two days. Previously she seldom felt nausea and vomiting but it has increased recently. She feels bloated and restless after the meals.

The doctor performed the examination and found positive Murphy and Blumberg sign, he also asked to get a Abdominal X-ray and CT scan done.

After the tests the doctor, confirmed the diagnosis and prescribed the medication. Asked to take bland and less oil food, with consumption of food with less spice.

What do you think the doctor must have diagnosed?

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Acute Cholecystitis:-

  • Murphy’s sign positive
  • Pain in the right upper quadrant, worsens after fatty meals

Cholelithiasis:-

  • colicky intermittent pain
  • Pain often starts after meals, especially oily food

Peptic Ulcer Disease:-

  • Epigastric pain post-meals
  • Nausea, vomiting, bloating

Gastritis:-

  • Epigastric pain
  • vomiting undigested food
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It’s most likely Acute Cholecystitis

  • Murphy Sign positive
  • Pain after fatty meals(like ghee paratha) suggests biliary involvement.
    -Vomiting, bloating, nausea, and restlessness after meals.
    -Pain below the breast, especially in the right upper quadrant, aligns with gallbladder pain.
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Based on the history, symptoms, physical examination and findings the most probable diagnosis is acute cholecystitis.
This is because:

  • Pain after fatty food (ghee paratha) → Classic rigger for gallbladder attacks, as fats stimulate bile release.
  • Pain under the right breast (right upper quadrant) → Typical location for gallbladder pain.
  • Pain is episodic but worsened recently → Fits with biliary colic progressing to cholecystitis.
  • Nausea, vomiting, bloating → Common symptoms of gallbladder inflammation.
  • Restlessness after eating → Indicates postprandial discomfort due to poor bile drainage.
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Acute Cholecystitis? USG is the IOC. Why was it skipped?

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It’s acute cholecystitis

Reasons:

  1. classical Murphy sign is positive
  2. it gets worsen on having fatty foods
  3. pain below the breast in right upper quadrant specifically

USG has to be done to confirm my diagnosis

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