<s>[INST] hi doctor I had Gall Bladder surgery through LAPROSCOPY 3 months ago, I am seeing Yellow urine in the morning and pale yellow for the rest of the day. Do I need to go for Liver egymes test ? and I feel some pain at the incision area neat the chest after 3 months also, please help me in this regard. Thanks in advance sujeevan t [/INST] Hi this is Chat Doctor. My management plan will be based on 2 steps, explaining about the probable diagnosis and appropriate management. From your description I have 3 probable diagnosis:-1) incomplete gall-bladder removal with a residual stone in the remnant of gall-bladder2) possible CBD stone or slipped gall stone from gall-bladder to CBD leading to obstructive jaundice3) stricture incomplete or partial leading to obstructive jaundice. Firstly you should keep a track on the daily intake of water. Low intake of water can lead to yellow colored urine and can be attributed to hepatobiliary pathology. Now coming to management:- kindly do LFT and S.alkaline phosphatase and if it is elevated then we will proceed as per the situation:1) if it is due to remnant gall-bladder with retained stone then diagnostic laparoscopy witChatDoctorplete removal of remnant gall-bladder with retained stone should be done.2)if it is due to CBD stone then ERCP stenting/open/laparoscopic CBD exploration with stone removal and closure with t tube in situ to be done or open/lap choledochojejunostomy/roux-en-y hepaticojejunostomy to be done.3)if it is due to stricture CBD then resection with choledocho/roux en y hepaticojejunostomy can be done either by open/lap procedure.4) many gall bladder or CBD pathology is accompanied by an abnormal liver fatty liver or cirrhotic liver. If LFT is deranged for that condition it can be supplemented with Liv 52 DS 2-0-1, it has to be taken empty stomach in morning.- Also get your hepatitis panel checked. Regards. </s>