Question of the Week # 171

171)  A 54 year old woman presents with complaints of abdominal pain in the right upper quadrant that started 4 hours ago and is persistent. She denies any fever, nausea or vomiting.

On physical examination, there is mild tenderness in right upper quadrant. Her liver function tests reveal an AST (SGOT) 160U/L ( N= 5 to 40U/L) , ALT (SGPT) 240U/L( N= 8 to 55U/L)  , Alkaline phosphatase 110 U/L ( 40 TO 130U/L) , Total Bilirubin 1.2mg%.  An ultrasound of the gall bladder does not reveal any gall stones or pericholecystic fluid and shows a common bile duct diameter of 9mm (normal 6mm). The most appropriate next step in managing this patient:

A)     Hepatitis Serology

B)      Laparoscopic Cholecystectomy

C)      HIDA scan

D)     Endoscopic Retrograde Cholangiopancreatography (ERCP)

E)      Magnetic Resonance CholangiOpancreatography ( MRCP)

5 Responses

  1. D

  2. D

  3. D

  4. D

  5. D: ERCP (anything in Commonbile duct, next step ERCP)

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