A 39 year old female is admitted with biliary colic. Investigations show gallstones. A laparoscopic cholecystectomy is performed and a large stone is impacted in Hartman’s pouch. After the operation, she fails to settle and becomes jaundiced. Bile continues to collect from the drain placed at the surgical site. What is the most appropriate course of action?
A 50 year old man presents to the hospital with an episode of alcoholic pancreatitis. He makes progress slowly but steadily. He is reviewed clinically at 7 weeks following admission. On examination, he is seen with a diffuse fullness of his upper abdomen and on imaging, a collection of fluid is found to be located behind the stomach. Tests show that his serum amylase is mildly elevated. Which of the following is the most likely explanation?
A 39 year old woman is admitted with acute cholecystitis which fails to settle. During a laparoscopic cholecystectomy, the gallbladder has evidence of an empyema and Calots triangle is inflamed. The surgeon suspects that a Mirizzi syndrome has occurred. What is the most appropriate course of action?
A 46 year old politician with chronic hepatitis for several years visits the clinic for a review. Recently, his AFP is noted to be increased and an abdominal ultrasound demonstrates a 2.2cm lesion in segment V of the liver. What is the most appropriate course of action?
A 49 year old man is admitted with small bowel obstruction after having repeated episodes of abdominal pain. A laparotomy is performed and during surgery, a gallstone ileus is identified. Which of the following is the best course of action?
A 53 year old male presents with generalised right upper quadrant pain which started from the previous day. On admission, he is septic and jaundiced and there is tenderness in the right upper quadrant. What is the most likely diagnosis?
A 44 year old actor presents with an attack of mild acute pancreatitis. Imaging identifies gallstones but a normal calibre bile duct, and a peripancreatic fluid collection. Which management option would be the most appropriate?
A 40 year old male presents with jaundice and is diagnosed as having a carcinoma of the head of the pancreas. Despite being deeply jaundiced, his staging investigations are negative for metastatic disease. What is the best method of biliary decompression in this case?
A 43 year old housewife is admitted with colicky right upper quadrant pain. On clinical examination she has a mild fever and jaundice. An ultrasound scan shows gallstones and she is taken to theatre for an open cholecystectomy. During operation, Calots triangle is almost completely impossible to delineate. What is the most likely explanation?
A 39 year old male is identified as having gallstones after presenting with colicky right upper quadrant pain. An abdominal ultrasound scan was done. Which of the following is the best course of action?