Year Female Presents Explained for Students (Easy Guide)

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Original Question

A 56-year-old female presents to the emergency department with right upper quadrant pain for the past 36 hours. She also complains of nausea and multiple episodes of non-bilious vomiting over the same time period. She has a history of type II diabetes but is otherwise healthy. Her BMI is 33 kg/m’. She is afebrile with a heart rate of 90 beats/min and a blood pressure of 138/78 mmHg. Physical examination is remarkable for a jaundiced-appearing female with epigastric and right upper quadrant tenderness, but no masses. Laboratory evaluation reveals an AST of 162 U/L, an ALT of 135 U/L and a total bilirubin of 5.8 mg/dL. Abdominal ultrasound reveals a dilated common bile duct. Which of the following is the most appropriate next step in the management of this patient’s symptoms? (A) Elective surgical resection (B) Endoscopic retrograde cholangiopancreatography (C) Intravenous antibiotics (D) Percutaneous gall bladder drainage (E) Oral ursodiol

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