Biliary Tract Disease

Chapter 36 Biliary Tract Disease




Clinical Case Problem 1: 33-Year-Old Woman with Right Upper Quadrant Abdominal Pain


A 33-year-old woman comes to the emergency department with a 12-hour history of right upper quadrant (RUQ) abdominal pain. The pain is severe now but waxes and wanes and is associated with nausea and some episodes of vomiting. The pain sometimes radiates through to the back. She feels warm but has not checked her temperature. There is no diarrhea. Her last bowel movement was 1 day ago and was normal. The patient has no similar history in the past.


On examination, the patient is an obese young woman in some discomfort. Her vital signs reveal a temperature of 100°F and pulse of 102 beats/minute. Her blood pressure is 130/70 mm Hg, and her respirations are 18 breaths/minute. There is no scleral icterus. The chest is clear, and the cardiovascular examination is normal. Abdominal examination reveals marked upper abdominal tenderness with guarding, especially in the RUQ. On palpation of the RUQ of the abdomen when the patient is asked to take a deep breath, there is a marked increase in pain. The bowel sounds are present but seem slightly sluggish. The patient has no drug allergies and is not taking any medications at present.



Select the best answer to the following questions




1. What is the most likely diagnosis in this patient?


a. acute cholecystitis

b. biliary colic

c. acute gastroenteritis

d. ileocecal appendicitis

e. Crohn disease

2. Given this patient’s signs and symptoms, which of the following investigative procedures will you order next to help with the diagnosis?


a. computed tomography (CT) scan of the abdomen

b. hydroxy iminodiacetic acid (HIDA) scan

c. abdominal ultrasonography

d. magnetic resonance imaging (MRI) of the abdomen

e. plain radiograph of the abdomen

3. What is (are) the treatment(s) of choice for the patient at this time?


a. intravenous fluids

b. parenteral antibiotics

c. adequate pain control

d. laparoscopic cholecystectomy within 24 to 48 hours

e. all of the above

4. Complications of gallstones include all of the following except


a. acute cholecystitis

b. hydrops of the gallbladder

c. gastric outlet obstruction

d. hepatic vein thrombosis

e. acute biliary pancreatitis

5. Regarding the definitive procedure to correct this condition, which of the following statements is true?


a. a definitive surgical procedure should not be contemplated at this time; if required, it should be performed several months later

b. a definitive surgical procedure should not be contemplated at this time; if symptoms continue to recur, you can reconsider

c. a definitive surgical procedure should be performed at this time

d. a definitive surgical procedure is contraindicated given the signs and symptoms with which this patient presents

e. a definitive surgical procedure should not be considered until all other methods of treatment have failed

6. Which of the following statements about gallbladder disease in the United States is (are) true?


a. more than 20 million Americans have gallstones

b. more than 300,000 cholecystectomies are performed annually

c. most gallstones are composed predominantly of cholesterol

d. diabetics have an increased prevalence of gallstones

e. all of the above

7. Regarding the use of nonsurgical therapy in gallstone disease, which of the following statements is true?


a. oral dissolution therapy is an excellent option for most patients

b. few if any gallstones that are dissolved with oral dissolution therapy recur

c. the preferred agent for oral dissolution therapy is ursodiol

d. oral dissolution therapy should not be combined with extracorporeal shock wave lithotripsy (ESWL)

e. oral dissolution therapy works best in patients with large gallstones

8. Which of the following statements regarding the treatment of asymptomatic gallstones is most accurate?


a. asymptomatic gallstones should be treated with oral dissolution therapy

b. asymptomatic gallstones should not be treated

c. treatment of asymptomatic gallstones depends on the presence or absence of comorbid conditions

d. asymptomatic gallstones should be treated with laparoscopic cholecystectomy, whereas symptomatic gallstones should be treated with open cholecystectomy

e. for asymptomatic gallstones, the treatment of choice is ESWL

9. What is the most common complication during laparoscopic cholecystectomy?


a. excessive bleeding

b. small bowel perforation

c. injury to the biliary tract system

d. inability to remove the gallbladder through the laparoscope

e. liver laceration

10. Which of the following statements is (are) true regarding laparoscopic cholecystectomy?


a. laparoscopic cholecystectomy provides a safe and effective treatment for most patients with symptomatic gallstones; it is the treatment of choice

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Oct 1, 2016 | Posted by in GENERAL SURGERY | Comments Off on Biliary Tract Disease

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