A 45-year-old woman with a known tumour in the superior (first) part of the duodenum complains of right upper quadrant pain and jaundice. A CT scan of the abdomen reveals that the tumour is causing obstruction of the biliary tree by pressing against it. Which segment of the biliary tree is most likely to be impacted?
A 55-year-old librarian presents with a 4-month history of abdominal discomfort and pain after consuming fatty meals. She undergoes an ultrasound of her gallbladder, which shows multiple stones.
What is the most frequent observation in an individual with gallstones?
A 35-year-old stockbroker has been experiencing difficulty swallowing solids for the past few months, while having no trouble swallowing liquids. He does not smoke and denies any alcohol consumption. His medical history is unremarkable except for the fact that he has been using antacids and H2-receptor blockers for gastro-oesophageal reflux disease for the past 5 years, with little relief from symptoms. Upon examination, there are no notable findings.
What is the probable reason for this man’s dysphagia?
A 68-year-old man has come in with jaundice and no pain. His doctor has noted a possible palpable gallbladder. Where is the fundus of the gallbladder most likely to be palpable based on these symptoms?
In a 30-year-old patient with chronic obstructive pulmonary disease (COPD) and hepatic dysfunction, a liver biopsy revealed the presence of eosinophilic, round globules within the periportal hepatocytes. These globules ranged in size from 5 to 40 µm and were surrounded by a halo. Additionally, they were found to be periodic acid-Schiff (PAS)-positive and diastase-resistant. What is the most probable substance that makes up these globules?
A 25-year-old woman comes to the Emergency Department with complaints of vomiting blood. She states that she had a heavy night of drinking and has vomited multiple times this morning. After the fourth time, she noticed about a tablespoon of fresh blood mixed in with the vomit. What is the probable reason for her haematemesis?
A 54-year-old man with persistent dyspepsia was being evaluated at the nearby medical center. While performing oesophago-gastro-duodenoscopy (OGD), the endoscopist inserted the endoscope until it reached the oesophageal hiatus of the diaphragm.
At which vertebral level is it probable that the endoscope tip reached?
A 45-year-old woman comes to the Surgical Admissions Unit complaining of colicky abdominal pain and vomiting in the right upper quadrant. The pain started while eating but is now easing. During the examination, she appears restless and sweaty, with a pulse rate of 100 bpm and blood pressure of 125/86. An abdominal ultrasound reveals the presence of gallstones.
What is the most frequent type of gallstone composition?
A 42-year-old mechanic visits his GP complaining of intermittent jaundice that has been occurring for the past 5 months. He has been feeling fatigued lately and occasionally experiences mild itching on his arms. He denies any pain or weight loss. The patient has a history of ulcerative colitis, which was diagnosed 13 years ago and has been managed with mesalazine, anti-diarrhoeals, and steroids. The GP orders liver function tests, which reveal the following results:
total bilirubin 38 mmol/l
aspartate aminotransferase (AST) 32 iu/l
alanine aminotransferase (ALT) 34 iu/l
alkaline phosphatase 310 u/l.
What is the most probable diagnosis?
A 31-year-old woman complains of abdominal pain, nausea, and vomiting. An ultrasound scan reveals the presence of gallstones and an abnormal dilation of the common bile duct measuring 7 mm. The patient is currently taking morphine for pain relief. After four hours, the pain subsides, and she is discharged without any symptoms. Two weeks later, she returns for a follow-up visit and reports being symptom-free. What is the most appropriate next step in managing her condition?