We were on call on day 10. I saw one new patient – a 38-year-old man with abdominal pain. His pain started in the middle of the night – it was sharp, mid-epigastric without radiation. He had several episodes of vomiting.
At the bedside I took a food history. He had eaten a tuna salad sandwich for lunch on Sunday – he made the tuna salad fresh and the mayonnaise came from the refrigerator. He ate "a lot of junk" food later that day.
He denies any previous such pain history. He has no major medical problems.
I saw him in the afternoon; the pain had receded from 8/10 to 3/10. He denied any diarrhea.
His exam revealed some mid-epigastric tenderness, but no guarding or rebound.
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This morning he felt back to normal and was hungry. His labs were all normal. CT of the abdomen showed one gallstone; RUQ ultrasound showed multiple stones.
Does he need a cholecystectomy?
{ 3 comments… read them below or add one }
To me, not yet.
Without knowing the thickness of the walls of the gallbladder, I would say that I cannot make a surgical determination.
However, just because the mayo was in the fridge, does not mean that it had not previously spent considerable time out of the fridge… or other ingredients/meals.
My feeling is without marked inflammation in the gallbladder it is of gastric or pancreatic origin.
Jared – Commercially prepared mayo is pretty good to go even when opened and left out of the refrigerator for hours. OTOH – I'm not sure why anyone would leave mayo out for hours – or use warm mayo in a salad of any kind (unless the mayo came from an unopened jar and the salad was to be refrigerated). So I would pretty much rule out GI problems as a result of food poisoning.
Not being a doctor (just a decent cook who has never poisoned anyone) – don't have a clue about any other Dx. I would ask the patient if he experienced constipation – not only diarrhea (some GI problems can present with either or both symptoms). I would also ask him how much junk food he had – what kinds – and how much beer he drank to wash it down (smile)? Also how often he ate this way. Also whether he ever had pain on a scale of 8/10 before – and what it was (many guys are kind of wusses when it comes to pain).
BTW – don't know beans about gallstones (never had any – knock wood) - but here is an explanation for non-doctors:
http://womenshealth.about.com/cs/gallbladder/a/gallstonessymtr.htm
Robyn