Patient History: A 79-year-old presents to an outpatient clinic with a 3 - month history of intermittent right upper quadrant abdominal discomfort, loss of appetite and general lethargy. It is colicky, in acute recurrent episodes lasting 60s, usually for a few days at a time. He is then pain-free for a few weeks. He is intolerant of fatty foods and describes excessive flatulence. There is no change in his bowel habit and no urinary symptoms. He has not been feverish. Physical Examination: The patient is clinically well.
He is not jaundiced. There is tenderness to deep palpation in the right upper quadrant with active bowel sounds. There is no palpable organomegaly. Laboratory FIndings: His blood tests confirmed normal liver function. Amylase was normal. The abdominal ultrasound showed a fatty liver and an 11 mm gallbladder calculus, with sludge in the gallbladder. The gallbladder was…
