A 36 yr old female, G7P7, presents to the ER complaining of severe abdominal pai

Question

A 36 yr old female, G7P7, presents to the ER complaining of severe abdominal pain. Her last pregnancy was five years ago. To prevent further pregnancy, she has been taking oral contraceptive pills for the past four and a half years. She is obese and physical exam is remarkable for right upper quadrant pain, negative Murphy's sign, and jaundice. Laboratory is significant for an elevated bilirubin level. Which ancillary test would you request to confirm your diagnosis? What is most likely diagnosis? What would you advise this patient to do? What is the pathogenesis to her condition?

Explanation / Answer

Gall stones or cholecystitis is the most likely diagnosis. The use of oral contraceptives for long time and obesity are contributing factors to gal stones. Right upper quadrant pain, negative murphy's sign, and jaundice further represent the same condition.

The cystic dust get blocked with gall stones in cholecystitis. Build up of bile puts and increased pressure, causing inflammation to gall bladder and damage to the bladder walls. Inflammation further reduces the blood flow and may lead to cell death or tissue death.

The pateint is adivced for diagnostic tests for C-reactive protein levels in blood, aminotransferases, ultrasound (the most common diagnosis). Hepatic iiodiacetic acid may be tested if ultrasound is of no use.

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