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Cytology rounds 9 April carcinoma gall bladder.pptx

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Cytology Rounds GE 2 09-04-2024
Personal details • Mrs KD • 39yr/F • R/o Bihar • Informant – Self
Chief complaints Pain abdomen x 04 months Jaundice x 04 months
Pain abdomen • Insidious onset • Progressive • Right upper quadrant • Dull aching • Mild to moderate in intensity • No radiation • No aggravating or relieving factors
Jaundice • Yellowing discoloration of urine and eyes • Insidious onset • Progressive
• H/o pruritus+ • H/o clay colored stools+ • H/o wt loss + (unquantified) • H/o loss of appetite +
Negative history • No h/o CAM intake • No h/o abdominal lump • No h/o hematemesis/melena • No history of HPB surgery.
Past history Personal history • No h/o major illness in the past. • No h/o diabetes mellitus • No h/o hypertension • No h/o major surgery in the past. • Non alcoholic, non smoker • Mixed diet • No h/o tobacco or drug abuse
Examination • Average built and nourishment • Conscious, oriented • Icterus + • No pallor, cyanosis, clubbing, Lymphadenopathy or Edema • Vitals • PR 88/min • BP 110/70 mmHg • SpO2 99% on Room air
Systemic examination • GIT • PA soft • Mild tenderness Rt hypochondrium • Liver palpable 3 cm below RCM • Gall bladder palpable • No evidence of free fluid in abdomen • Bowel sounds + • spleen was not palpable. • CNS • Conscious, alert, oriented to time, place and person • No focal deficit • RS • Normal vesicular breath sounds bilateral lung fields. • CVS • S1, S2 normal • No S3/S4/murmur
Investigations Investigations Reports Hb (g/dl) 8.5 TLC (/mm3 ) 5410 DLC (N/L) 43/41 Plt (/mm3 ) 3.04L Urea/Creatinine (mg/dl) 12/0.62 Na/K (meq/L) 136/4.7 T.Bil /Dir (mg/dl) 11.71/8.7 AST/ALT (IU/L) 57/88 ALP (IU/L) 972U/L T.P/Alb (mg/dl) 6.5/3.3
USG Abdomen  Liver 18cm  GB partially distended, asymmetric wall thickening in fundus and body with echogenic contents within ? sludge
CECT Abdomen • GB – Diffuse asymmetric circumferential wall thickening. There is indistinct interface between GB and contiguous liver segments 5 and 4a. Thickening involves CHD and primary confluence with resultant bilobar IHBRD.
EUS • EUS FNB taken from the lesion
• Unit Diagnosis Carcinoma Gall Bladder • Lab ID - 2931

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Cytology rounds 9 April carcinoma gall bladder.pptx

  • 1. Cytology Rounds GE 2 09-04-2024
  • 2. Personal details • Mrs KD • 39yr/F • R/o Bihar • Informant – Self
  • 3. Chief complaints Pain abdomen x 04 months Jaundice x 04 months
  • 4. Pain abdomen • Insidious onset • Progressive • Right upper quadrant • Dull aching • Mild to moderate in intensity • No radiation • No aggravating or relieving factors
  • 5. Jaundice • Yellowing discoloration of urine and eyes • Insidious onset • Progressive
  • 6. • H/o pruritus+ • H/o clay colored stools+ • H/o wt loss + (unquantified) • H/o loss of appetite +
  • 7. Negative history • No h/o CAM intake • No h/o abdominal lump • No h/o hematemesis/melena • No history of HPB surgery.
  • 8. Past history Personal history • No h/o major illness in the past. • No h/o diabetes mellitus • No h/o hypertension • No h/o major surgery in the past. • Non alcoholic, non smoker • Mixed diet • No h/o tobacco or drug abuse
  • 9. Examination • Average built and nourishment • Conscious, oriented • Icterus + • No pallor, cyanosis, clubbing, Lymphadenopathy or Edema • Vitals • PR 88/min • BP 110/70 mmHg • SpO2 99% on Room air
  • 10. Systemic examination • GIT • PA soft • Mild tenderness Rt hypochondrium • Liver palpable 3 cm below RCM • Gall bladder palpable • No evidence of free fluid in abdomen • Bowel sounds + • spleen was not palpable. • CNS • Conscious, alert, oriented to time, place and person • No focal deficit • RS • Normal vesicular breath sounds bilateral lung fields. • CVS • S1, S2 normal • No S3/S4/murmur
  • 11. Investigations Investigations Reports Hb (g/dl) 8.5 TLC (/mm3 ) 5410 DLC (N/L) 43/41 Plt (/mm3 ) 3.04L Urea/Creatinine (mg/dl) 12/0.62 Na/K (meq/L) 136/4.7 T.Bil /Dir (mg/dl) 11.71/8.7 AST/ALT (IU/L) 57/88 ALP (IU/L) 972U/L T.P/Alb (mg/dl) 6.5/3.3
  • 12. USG Abdomen  Liver 18cm  GB partially distended, asymmetric wall thickening in fundus and body with echogenic contents within ? sludge
  • 13. CECT Abdomen • GB – Diffuse asymmetric circumferential wall thickening. There is indistinct interface between GB and contiguous liver segments 5 and 4a. Thickening involves CHD and primary confluence with resultant bilobar IHBRD.
  • 14. EUS • EUS FNB taken from the lesion
  • 15. • Unit Diagnosis Carcinoma Gall Bladder • Lab ID - 2931