Case Story – “Every stomach ache is not Acidity.”
With our changing lifestyle and eating habits, the incidence of acidity and bloating are increasing among population which may or may not be associated with nausea and vomiting.
Something similar happened with Mrs. Sangeeta, 45yr old female with BMI 35.4 (Height – 150, Weight – 88kg). When she started feeling pain in her abdominal (right hypochondriac region), along with nausea and vomiting (1-2 episodes/day), for which she took some analgesics, a proton pump inhibitors (PPI) as per medicine vendor’s suggestion. She got relieved with these medicines to some extent. Now, she developed dyspepsia along with pain in right hypochondriac region. The intensity of pain increased day by day. Finally her husband took her to emergency department. Pain score was found to be 7/10. The doctor on duty took her history and got to know that this kind of similar episode happened two months ago also. Her vitals were found within normal limit, Random blood sugar was 150mg/dl (normal <140mg/dl); she was not taking any medication, no history of comorbidities.
On examination:
• Extreme tenderness in right hypochondriac region
• No mass felt
• No other abdominal signs (guarding, rigidity)
• No icterus

After examination doctor recalled a very interesting line from his teachings, “Fatty, Fertile, Forty year and Female Patients are at increased risk of developing gall bladder stone and related complications.”
The doctor managed her initially by keeping her NPO (Nil Per Oral), started IV fluids, analgesics along with antibiotics like Ceftriaxone and Metronidazole and ordered workup for possible gall bladder stone and related complications like pancreatitis, Cholangitis.
Blood investigation (CBC, LFT, PT INR, Amylase and lipase) were sent to the laboratory. Then she was taken up for ultrasonography imaging.
On USG of abdomen, wall echo shadow sign (post-acoustic shadow) was seen and CBD (common bile duct) was found to be distended-10mm in size (Normal-1.8mm to 5.9mm).
The blood report showed leukocytosis (TLC 13,000). Serum lipase, amylase and bilirubin were within normal limit but alkaline phosphatase was raised.
On taking consultation from surgeons and pre- anesthesia check-up (PAC), she was taken for magnetic resonance cholangiopancreatography (MRCP) to look out for stone in CBD and a shadow was seen in the lower half of CBD, confirming that it’s a stone.
Following this, Endoscopic retrograde cholangiopancreatography (ERCP) and Sphincterotomy was done without any complications. After few days, she was taken for laparoscopic cholecystectomy, and this solved her struggle with pain.
She was hospitalized for 3-4 days and was advised to take precautions for 4-6 weeks, after which she could resume her work. She was also made aware of complications like cholangitis, pancreatitis.
A nutritionist made proper diet chart  which mentioned avoiding high fat foods, canned juices, coffee, wine, red meat etc. She was told to avoid sugar and carbs as well.
Mrs. Sangeeta’s case is a good example for all of us to understand that you need to understand the signs your body gives and not ignore it always.