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  #1  
Old 09-01-2011
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Liver Site of Gallstone Impaction!

A patient with known gallstones is admitted with a temperature of 103.2 F, BP 143/67, and HR 112. Physical exam reveals tenderness in her epigastrium. She states that her pain is exacerbated by lying flat on her back. Labs are significant for: WBC 18.7
AST 57
ALT 48
Alkaline Phosphatase 129
Direct Bilirubin 0.2
Total Bilirubin 0.6
Amylase 1408
Lipase 1103 (reference range: 30 - 210 U/L)

In which of the following structures do you expect to find an impacted gallstone?
  • A. Neck of the gallbladder
  • B. Common bile duct
  • C. Common hepatic duct
  • D. Ampulla of Vater
  • E. Cystic duct
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  #2  
Old 09-01-2011
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Ampulla of Vater
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Old 09-01-2011
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it's D..ampulla of vater
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Old 09-01-2011
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ampulla of vater?
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Old 09-02-2011
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the correct answer is ampulla of vater
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Old 09-02-2011
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Holy smokes! HIGH YEILD STEP 1 QUESTION!!! Make sure you know this lol
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Old 09-02-2011
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They're giving you amylase and lipase. Meaning acute pancreatitis secondary to a gallstone which moved down to the ampulla of vater. Also the pain in her back is a good hint. Good question!
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Old 09-03-2011
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so the answer is d?
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Old 02-21-2012
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The answer is definitely d
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Old 02-21-2012
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D with out a question...
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Old 02-21-2012
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Maybe I am mistaken but but some time ago I had a case where I find an impacted gallstone in a neck of the gallbladder??!!
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