Approach to jaundice (conjugated hyperbilirubinemia) Quiz: Ace Your Exams
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A 39-year-old woman is brought to the emergency department for evaluation of right upper abdominal pain, vomiting, and confusion for the past 2 days. Her temperature is 39.7 °C (103.6 °F), blood pressure is 115/65 mm Hg, and pulse rate is 104/min. The patient is alert but confused. Physical examination shows scleral icterus and right-upper-quadrant tenderness with guarding. Laboratory evaluation is shown below. Abdominal ultrasound demonstrates multiple stones in the gallbladder without gallbladder wall thickening or pericholecystic fluid. The diameter of the common bile duct (CBD) is 8 mm, with a small stone visualized. Blood cultures are obtained and empiric treatment with intravenous piperacillin-tazobactam is initiated. Which of the following is the most appropriate next step in management?
| Laboratory value | Result |
| Complete Blood Count (CBC) | |
| Hemoglobin | 13 g/dL |
| White blood cell count (WBC) | 13,000/mm3 |
| Liver Function Tests | |
| Alkaline Phosphatase (ALP) | 300 u/L |
| Alanine aminotransferase (ALT) | 238 u/L |
| Aspartate aminotransferase (AST) | 159 u/L |
| Total bilirubin | 6 mg/dL |
| INR | 1.3 |
| Serum chemistry | |
| Lipase | 50 U/L |
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