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Old 08-17-2012
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Liver Gallstone question

A 42-year-old woman has two children complains about pain attacks in the right subcostal region for about a year. The pain arises mainly after taking fattening food. Over the last week the attacks occurred daily and became more painful. On the 3rd day of hospitalization the patient presented with icteritiousness of skin and scleras, light-colored feces and dark urine. In blood: neutrophilic leukocytosis 13,1*109/l, ESR - 28 mm/h. No pain elicited on palpation of the right subcostal region. which of the following will lead the attending physician to an alternative suspicion of ascending cholangitis.

a) Leukocytosis
b) Negative murphy's sign
c) Fever
d) Jaundice
e) RUQ pain
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Old 08-17-2012
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I would say D
From Charcot's triad more specific sign is jaundice indicating blockage of common bile duct leading to ascending infection
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Old 08-17-2012
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Quote:
Originally Posted by MedicalExaminer View Post
I would say D
From Charcot's triad more specific sign is jaundice indicating blockage of common bile duct leading to ascending infection
but RUQ pain and fever is also part of the triad... and the question gives ascending cholangitis as an alternative diagnosis so that means a diagnosis has already been made....
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Old 08-17-2012
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Aa...
riased WBC count is in keeping with ascending cholangitis

charcots triad is non specific
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Old 08-17-2012
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Could be D.
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Old 08-17-2012
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Good arguments...i'l post the answer in a bit..
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Old 08-17-2012
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This patient is suffering from Choledocholithiasis (Remember four F's) presence of gallstones in the common bile duct leading to "gallstone attack" in which a person may experience intense pain in the upper-right side of the abdomen, often accompanied by nausea and vomiting, that steadily increases for approximately 30 minutes to several hours. A patient may also experience referred pain between the shoulder blades. Jaundice and/or clay-colored stool may raise suspicion of choledocholithiasis or even gallstone pancreatitis
However If the above symptoms coincide with fever and chills, leukocytosis the diagnosis of ascending cholangitis may also be considered. Acute cholangitis is a bacterial infection superimposed on an obstruction of the biliary tree most commonly from a gallstone, but it may be associated with neoplasm or stricture.
Although fever and leukocytosis are present leukocytosis is more specific for infection. Murphy's sign (pain with inspiratory arrest while palpating RUQ) is positive in cholecystitis and negative in both choledocholithiasis and ascending cholangitis.

Answer is A....
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The above post was thanked by:
Dr.Lacune (08-26-2012), MedicalExaminer (08-17-2012), slowpoke (08-18-2012), sruthi (08-18-2012), venky2600 (08-17-2012)



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