Gallstone ileus Quiz: Ace Your Exams
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A 42-year-old woman, gravida 3 para 3, is brought to the emergency department due to severe abdominal pain that started 3 hours ago. She describes the pain as sharp, constant, and rates it as 7/10 in intensity. Since the pain started, she has been feeling nauseous and has vomited twice. She reports a few episodes of similar abdominal discomfort in the past but says that this time it “feels different.” Temperature is 38.0°C (100.4°F), pulse is 80/min, and blood pressure is 135/85 mmHg. BMI is 32 kg/m2. The patient is in acute distress due to pain and points to the upper abdomen. The abdomen is tender to touch. No rebound tenderness or hepatomegaly is present. An abdominal ultrasound is performed and reveals a normal common bile duct with concomitant gallbladder wall thickening and free fluid around the gallbladder. Laboratory results are obtained and shown below:
Which of the following is the most likely diagnosis?
| Laboratory value | Result |
| Hemoglobin | 14 g/dL |
| Leukocyte count | 15,000 mm3 |
| Platelet count | 250,000 mm3 |
| Mean corpuscular volume | 90 μm3 |
| Serum | |
| Creatinine | 0.8 g/dL |
| BUN | 11 mg/dL |
| Bilirubin | |
| Total | 0.8 mg/dL |
| Direct | 0.2 mg/dL |
| Alanine aminotransferase | 18 U/L |
| Aspartate aminotransferase | 20 U/L |
| Amylase | 55 U/L |
| Lipase | 62 U/L |
| Alkaline phosphatase | 65 U/L |
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