Emergency Surgery Ambulatory Follow-up Letter

Diagnosis: Symptomatic cholelithiasis (biliary colic)

Abdominal Ultrasound: Multiple mobile gallstones within a thin-walled gallbladder; CBD 4 mm, no intrahepatic duct dilatation

Bloods (FBC, U&E, LFT, CRP): WCC 7.2 x 10^9/L, CRP 4 mg/L, Bilirubin 14 µmol/L (ALT 32 U/L, ALP 88 U/L).

Plan: Conservative management with analgesia and low-fat diet advice. Refer to General Surgery outpatient clinic to discuss elective laparoscopic cholecystectomy.

It was good to see you today in the Emergency Surgery Ambulatory Care (ESAC) clinic. You attended with your husband. You describe 3 days of intermittent right upper quadrant pain. You explained that the pain radiates to the interscapular region and is triggered by fatty meals. This was accompanied by mild nausea, although your bowel habit has remained unaffected. You also report occasional epigastric bloating.

Your medical history includes hypertension, for which you currently use amlodipine 5 mg PO OD. In addition, you take paracetamol 1,000 mg PO QDS PRN to treat knee osteoarthritis.

Today, you looked comfortable at rest and were independently mobile. Your BMI was around 28 kg/m² (76 kg). Abdominal examination found a soft abdomen with mild deep tenderness in the RUQ, Murphy's sign negative, and no guarding or peritonism.

Recent blood results indicate no evidence of systemic inflammation. They also demonstrate normal liver function and renal profile. An abdominal ultrasound performed today was diagnostic for gallstones, with no sonographic evidence of acute cholecystitis or biliary tree obstruction specifically noted.

We are still waiting for your formal lipid profile results. For now, I have reassured you that there are no signs of acute infection requiring emergency admission or surgery today. In future, an MRCP may be useful to exclude microlithiasis within the common bile duct if your LFTs become deranged. We will update you about your outpatient surgical clinic appointment by post.