Question 1

A patient has sudden onset of right upper quadrant (URQ) and epigastric abdominal pain with fever, nausea, and vomiting. The emergency department provider notes yellowing of the sclerae. What is the probable cause of these findings?

A) Acute acalculous cholecystitis
B) Chronic cholelithiasis
C) Common bile duct obstruction
D) Infectious cholecystitis

C

Accepted Answer

The combination of right upper quadrant and epigastric pain, fever, nausea/vomiting, and yellowing of the sclerae is highly suggestive of a common bile duct obstruction. The obstruction may be due to various causes, including a stone lodged in the duct, inflammation, or malignancy. Acute acalculous cholecystitis and infectious cholecystitis can present with similar symptoms but would not typically cause yellowing of the sclerae. Chronic cholelithiasis may also cause epigastric pain but is not associated with fever or scleral icterus.

Question 2

Which diagnostic test will the provider safely order for a 30-year-old woman reporting right upper quadrant abdominal pain, nausea, and vomiting?&#10;A) Abdominal computed tomography (CT) with contrast&#10;B) Abdominal ultrasound&#10;C) Magnetic resonance imaging (MRI) of the abdomen&#10;D) Plain abdominal radiographs

Accepted Answer

Abdominal ultrasound is the best initial imaging modality to evaluate possible biliary tract disease, such as cholecystitis or choledocholithiasis, in a young woman presenting with right upper quadrant abdominal pain, nausea, and vomiting. CT with contrast or MRI may be ordered if further evaluation is needed or if the ultrasound is inconclusive. Plain abdominal radiographs are not useful for evaluating biliary tract disease.

Question 3

A patient with a previous history of liver disease is diagnosed with a bile duct obstruction. Which procedure will be prescribed for this patient?&#10;A) Chemical dissolution of the gallstone&#10;B) Lithotripsy&#10;C) Open cholecystectomy&#10;D) Laparoscopic cholecystectomy

Accepted Answer

Since the patient has a previous history of liver disease, a surgical removal of the obstruction via open cholecystectomy would be the safest option. Chemical dissolution and lithotripsy are non-surgical options typically reserved for patients without a history of liver disease. Laparoscopic cholecystectomy may also be a viable option but may carry risks due to the patient's history of liver disease.

Question 4

A patient presents with fever, nausea, vomiting, anorexia, and right upper quadrant abdominal pain. An ultrasound is negative for gallstones. Which action is necessary to treat this patient's symptoms?

A) Empirical treatment with antibiotics
B) Hospitalization for emergent treatment
C) Prescribing ursodeoxycholic acid
D) Supportive care with close follow-up

Accepted Answer

The answer of A patient presents with fever, nausea, vomiting,...

Deck 111: Cholelithiasis and Cholecystitis