Gall Bladder Disease – Post Test

A 37-year-old female presents to the emergency department (ED) with right upper quadrant (RUQ) pain. Which of the following clinical features most suggests biliary colic?

It is now 0400 in the ED and your patient is now completely well and pain-free. Which of the following investigations are most likely to be abnormal if the patient has biliary colic?

A 65-year old man presents to the ED with RUQ pain and jaundice. He complains of recent pale stools and dark urine. Initial results reveal HB 120, WCC 8.0, ALP 320, AST 300, GGT 120, bilirubin 50 and amylase 90.

Which of the following is the most likely diagnosis?

A 45-year-old female presents to the ED with abdominal pain. Which of the following is the most sensitive physical examination finding for a diagnosis of acute cholecystitis?

In this patient USS reveals stones in the gall bladder and a thickened gall bladder wall.

Which is the management strategy the surgeons are most likely to choose?

You discuss the suspected diagnosis with the patient and they ask why they have developed gall stones.

Which of the following are likely contributors?

At 0600 you receive a standby call for a 70-year-old male with severe upper abdominal pain. Ambulance crew tells you he is due to be admitted at 0800 that day for an elective cholecystectomy. On arrival he is feverish and vomiting, his pulse is 126 and his BP is 90/50 mmHg.

What would be your best initial management?

The patient’s BP is now 120/70 mm Hg, pulse 90 and temperature 40.1°C. You suspect ascending cholangitis.

Which of the following is an appropriate antibiotic regime?

After 2 L of saline the patient looks increasingly unwell with severe pain and poor peripheral perfusion. There is no evidence of jaundice. Bloods are pending. Examination reveals diffuse abdominal tenderness and guarding.

Which of the following is the most likely diagnosis?