11-28-2008, 12:20 PM
A 42-year-old woman, gravida 3, para 3, comes to the
emergency
department 24 hours after the onset of moderate
epigastric pain radiating to
the back. Her last menstrual period was 3 weeks ago.
She has no history
of serious illness and has never undergone an
operative procedure. She
weighs 72 kg (160 lb) and is 157 cm (62 in) tall. Her
temperature is
37.2 C (99 F), blood pressure is 130/90 mm Hg, and
pulse is 100/min.
Abdominal examination shows mild distention,
epigastric tenderness, and
voluntary guarding. Test of the stool for occult
blood is negative.
Laboratory studies show:
Hematocrit 44%
Leukocyte count 12,000/mm3
Serum
Na+ 138 mEq/L
Cl“ 100 mEq/L
K+ 4 mEq/L
HCO3“ 25 mEq/L
Bilirubin, total 1.6 mg/dL
Alkaline phosphatase 100 U/L
Aspartate aminotransferase
(AST, GOT) 14 U/L
Alanine aminotransferase
(ALT, GPT) 12 U/L
Amylase 1100 U/L
Ultrasonography shows gallstones; the gallbladder wall
is 1 mm and the
common bile duct is 5 mm in diameter. Which of the
following is the
most likely diagnosis?
A
) Acute cholecystitis
B
) Acute pancreatitis
C
) Acute perihepatitis
D
) Ascending cholangitis
E
) Duodenal ulcer
F
) Viral hepatitis
B ???
emergency
department 24 hours after the onset of moderate
epigastric pain radiating to
the back. Her last menstrual period was 3 weeks ago.
She has no history
of serious illness and has never undergone an
operative procedure. She
weighs 72 kg (160 lb) and is 157 cm (62 in) tall. Her
temperature is
37.2 C (99 F), blood pressure is 130/90 mm Hg, and
pulse is 100/min.
Abdominal examination shows mild distention,
epigastric tenderness, and
voluntary guarding. Test of the stool for occult
blood is negative.
Laboratory studies show:
Hematocrit 44%
Leukocyte count 12,000/mm3
Serum
Na+ 138 mEq/L
Cl“ 100 mEq/L
K+ 4 mEq/L
HCO3“ 25 mEq/L
Bilirubin, total 1.6 mg/dL
Alkaline phosphatase 100 U/L
Aspartate aminotransferase
(AST, GOT) 14 U/L
Alanine aminotransferase
(ALT, GPT) 12 U/L
Amylase 1100 U/L
Ultrasonography shows gallstones; the gallbladder wall
is 1 mm and the
common bile duct is 5 mm in diameter. Which of the
following is the
most likely diagnosis?
A
) Acute cholecystitis
B
) Acute pancreatitis
C
) Acute perihepatitis
D
) Ascending cholangitis
E
) Duodenal ulcer
F
) Viral hepatitis
B ???