Claire jackson 924637 53 year old lady presented complaint abdominal pain past medical history laparoscopic cholecystectomy with ultrasound examination of the bile duct april 2022 laparoscopic cholecystectomy with bile duct ultrasound under mister sinha april 2022 undertaking this day case and no operative complications noted other medical history weber a fibular fracture october 2024 propranolol for anxiety citalopram for anxiety ehlers myotomy at age 12 laparoscopic sigmoid colectomy 2014 social history works as a nurse lecturer at plymouth university at the royal and at the royal devon and exeter hospital presenting complaint right upper quadrant pain history of presenting complaint patient says right upper quadrant pain feeling very similar to previous gallstones not related to eating no vomiting diarrhea dysuria hematuria fevers chest pain shortness of breath investigations past medical history very high cholesterol and past medical history left bundle branch block ct coronary angiogram may 2025 cadrad 2 mild stenosis in the proximal lad and rca blood tests today usernie is normal alp a 196 alt 96 amylase normal crp 36 ast 69 mcv 81.6 and lymphocytes naught 0.89 but remainder of full blood count normal impression possible retained stone post cholecystectomy plan ultrasound abdomen if stone proven then aim for ercp next week number next analgesia number next full escalation number next vt prophylaxis number next monitor inflammatory markers and if increasing consider treating for biliary infection however note bilirubin normal at 10 low threshold for cross sectional imaging if in severe pain but ultrasound will be more sensitive for intraductal stone and ordering this in the first instance if choledocholithiasis is proven then for ercp we did briefly discuss the procedure of ercp including risks and benefits today at the bedside on examination heart sounds normal chest sounds normal white upper quadrant tenderness on deep palpation no peripheral edema or rashes social history she's independent non smoker non drinker