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  #1  
Old 03-07-2012
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Liver Small bowel air fluid levels and air in the liver!

A 77-year-old woman comes to the physician because of a 2-day history of cramping abdominal pain and distention accompanied by nausea and vomiting. She is otherwise healthy and has no history of abdominal operations. Her temperature is 37.4 C (99.4 F), blood pressure is 110/86 mm Hg, pulse is 112/min, and respirations are 24/min. Cardiopulmonary examination shows no abnormalities. Examination of the abdomen shows distention and mild diffuse tenderness; bowel sounds are high-pitched. An x-ray film of the abdomen shows air-fluid levels throughout the small bowel and air in the liver; there is no gas in the colon or free air.
Which of the following is the most likely diagnosis?

A) Adhesive small-bowel obstruction
B) Cecal cancer
C) Gallstone ileus
D) Intussusception
E) Mesenteric infarction
F) Ruptured appendicitis
G) Small bowel lymphoma
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  #2  
Old 03-07-2012
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i guess mesenteric infarction :sorry:. not sure. there is air in the portal vein in mesenteric infarction with some thumbprinting too.
whats the ans
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Old 03-07-2012
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C ) Gallstone ileus
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  #4  
Old 03-07-2012
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C gall stone ileus, gas in liver but no gas in large intestine, and increase small bowel sound due to obstruction stone obs the ileocecal wall.
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dr.dhruvdesai (03-07-2012)
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Old 03-07-2012
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Quote:
Originally Posted by usmlepak View Post
C gall stone ileus, gas in liver but no gas in large intestine, and increase small bowel sound due to obstruction stone obs the ileocecal wall.
there is gas in gall bladder...
is there gas in liver in gallstone ileus?
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Old 03-07-2012
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Quote:
Originally Posted by tyagee View Post
there is gas in gall bladder...
is there gas in liver in gallstone ileus?
yes it can be back flow of gas/air can go to liver, gall bladder or in biliary tree,
qs is confusing thru this way its gallstone ileus
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Old 03-07-2012
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ya i think usmlepak's explanation is correct

gas in liver=gas in gallbladder...wat they mean here...

see this is a rule=look for characteristics of other dz in the questiion when u have a doubt with the ans...

if the typical scenario of other options is not present then ur guess is most probably correct....its a trick...

so even if this is not absolutely classic...it is somewhat classic scenario...rule out others...which we can easily in this case
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