Gallstones Quiz: Ace Your Exams
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A 55-year-old woman is brought to the emergency department due to progressive upper abdominal pain and fever for the past 2 days. She states she has felt persistently nauseous over this time period and has vomited 5 times. Medical history is noncontributory. Temperature is 38.6°C (101.4°F), pulse is 80/min, and blood pressure is 135/85 mmHg. Examination reveals a patient in acute distress. Physical examination reveals yellow discoloration of the sclera. The abdomen is tender to palpation in the right upper quadrant. There is no rebound tenderness. No hepatomegaly is observed. Laboratory studies show the following:
Abdominal ultrasound shows dilation of the intra- and extrahepatic ducts. IV fluids and antibiotics are administered. Six hours later, the patient becomes disoriented. Temperature is 38.6°C (101.4°F), pulse is 101/min, and blood pressure is 95/60 mmHg. Which of the following is the most likely cause of this patient’s presentation?
| Laboratory value | Result |
| Hemoglobin | 14 g/dL |
| Leukocyte count | 17,000 mm3 |
| Platelet count | 240,000 mm3 |
| Mean corpuscular volume | 87 μm3 |
| Serum | |
| Creatinine | 0.8 g/dL |
| BUN | 12 mg/dL |
| Bilirubin | |
| Total | 3.8 mg/dL |
| Direct | 2.5 mg/dL |
| Alanine aminotransferase | 190 U/L |
| Aspartate aminotransferase | 210 U/L |
| Amylase | 57 U/L |
| Lipase | 65 U/L |
| Alkaline phosphatase | 412 U/L |
Abdominal ultrasound shows dilation of the intra- and extrahepatic ducts. IV fluids and antibiotics are administered. Six hours later, the patient becomes disoriented. Temperature is 38.6°C (101.4°F), pulse is 101/min, and blood pressure is 95/60 mmHg. Which of the following is the most likely cause of this patient’s presentation?
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