### instruction:
If you are a doctor, please answer the medical questions based on the patient's description.

### input:
I am a 37 year old female that works full time for an Internal Medicine Doctor s office. It gets very stressful at times as I am the only Clinical Nurse in the office that sees 25-40 patients a day. On 10/14/11 all of the the sudden I had tremendous (1-10 pain scale it was at least a 9 or 10) pain under the mid section of the rib cage.At the time of the onset of this attack I was in an exam room taking a patient s vitals & going through the normal routine of allergy, medications, etc. updates with the patient, nothing stressful. I had these attacks before but never as bad as this one, and the last attack was about 4-6 months ago & again, was doing nothing stressful at the time. The pain finally subsided after about 15-20 minutes (down to about a 3-4 out of 10). I excused myself from work & drove myself to the hospital (the hospital is 1/8 mi. away from my work). I went into the E.R. & explained to them what was going on, they immediately took an EKG & CXR that showed nothing. After talking with the E.R. Dr. & telling her about the last attack but that there was pain in my back associated with that one. The E.R. Dr. said it sounded like a classic case of gallbladder stones. They performed an U/S of the Gallbladder & it showed no stones however it was enlarged & dilated from what they said. Next, they performed an MRI w/o contrast that showed the gallbladder as distended for the patient s age , again no gallstones. I was D/C from the hospital & was told to follow up with a G.I for an Upper GI Endoscopy and to go from there. I have a history on my mother s side of her sibling s having their gallbladder s removed but at a much older age. I wanted to speak with a hematologist in regards of my lab results but on the same token give a bit of history as to which led up to the lab work being performed. All of the results came back in normal range except the following: WBC: 11.6 H ; RBC: 3.86 L ; MCH: 33.4 H ; Neutrophils: 80.0 H ; Lymphs: 15.4 L ; Monocytes: 3.7 L ; Neutro Absolute: 9.3 H & Glucose: 100 H Should I be worried about anything regarding the lab results & what do you recommend about the gallbladder situation? I extend a big Thank You in advance for your time and help in regarding my situation! -Theresa P.

### output:

Hello,1. Gallbladder with small calculi should be removed by laparoscopy as small stones bring risk of bile ducts obstruction and acute pancreatitis.2. Chronic liver parenchymal disease most likely means that you have fatty liver. You should avoid alcohol, fatty foods, spicy foods, medicines involving liver to reverse fatty liver process.3. Mild degree of splenomegaly should be consulted with hematologist as this can be a symptom of many diseases including leukemia, liver hypertension, infectious diseases.4. CBD borderline dilated can be caused by sludge or small stones inside. I suggest you to have liver tests (AST, ALT,GTP, AP), lipase, amylase, bilirubin checked. You should be operated anyway as small stones are more prone to move to bile ducts and cause acute pancreas disease. Hope I have answered your question. Let me know if I can assist you further. 