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  #1  
Old 01-15-2010
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Liver Acute cholecystitis vs biliary colic

55 y/o man with 2months history of intermittent, severe, sharp, abdominal pain that occurs primarily after meals and last about 30 to 60 minutes. There is no fever, diarrhea, or weight loss. Physical examination shows no abnormalities. Which of the following is the most likely responsible for these symptoms?

A) Acute cholecystitis
B) Ascending cholangitis
C) Biliary colic
D) Primary biliary cirrhosis
E) Sclerosing cholangitis

Which is the answer and why?
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Old 01-15-2010
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c, other choices can be excluded by the mere absence of fever

Remember:
- Colick +/- jaundice: stone
- Fever + severe dull pain (+/- jaundice not typically): acute cholecystitis
- Fever + jaundice + colick: ascending cholangitis
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Old 01-15-2010
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Quote:
Originally Posted by DrSeddik View Post
c, other choices can be excluded by the mere absence of fever
Nice thinking
But is it all the cases of PBS and Sclerosing cholangitis have fever?
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Old 01-15-2010
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It's possible that she has, PBC, it is a very remote possibility though, because the age is not typical, they didn't say anything about jaundice or itching, you can't possibly say it is PBC just because she has a biliary colick. Remember that in the USMLE sometimes 2 or more answers can be correct, you just have to choose the most commonly encountered answer even if the question doesn't say "most common". Fever and weight loss are very common in those 2 diseases, what I meant to say is there's nothing in the question that is odd for simple gall stones.
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Old 01-15-2010
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OOh, I thought the question says woman. Anyway, to diagnose sclerosing cholangitis you have to visualize the biliary tree, also weight loss and fever are very common.
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Old 01-16-2010
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Quote:
Originally Posted by DrSeddik View Post
OOh, I thought the question says woman. Anyway, to diagnose sclerosing cholangitis you have to visualize the biliary tree, also weight loss and fever are very common.
Thank you very much you are absolutely right
Wish you a great luck in your upcoming exam
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Old 02-13-2012
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Default billiary colic

what's the best inatial test?
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