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Medical Student Small Group Discussion Topics
Evaluation of the Jaundiced Patient
Suggested Reading
Current Diagnosis & Treatment: Surgery, Thirteenth EditionEdited by Gerard M. DohertyCopyright © 2010 by The McGraw-Hill Companies, Inc.
Chapter 25. Biliary Tract
Schwartz's Principles of Surgery, 9e
Schwartz's Principles of Surgery, 9e F. Charles Brunicardi, Dana K. Andersen, Timothy R. Billiar, David L. Dunn, John G. Hunter, Jeffrey B. Matthews, Raphael E. Pollock Copyright © 2010, 2005, 1999, 1994, 1989, 1984, 1979, 1974, 1969 by The McGraw-Hill Companies, Inc.
Chapter 32. Gallbladder and the Extrahepatic Biliary System
Current Diagnosis and Treatment: Surgery
?Medical Student Small Group Discussion
TopicsEvaluation of the Jaundiced Patient
Outline the anatomy and embryology of the bile ducts, gallbladder, and pancreas.
?Medical Student Small Group Discussion
TopicsEvaluation of the Jaundiced Patient
Explain the mechanism of gall
stone formation
?Medical Student Small Group Discussion
TopicsEvaluation of the Jaundiced Patient
What types of gallstones can be formed?
?Medical Student Small Group Discussion
TopicsEvaluation of the Jaundiced Patient
What factors predispose to the
formation of gallstones?
?Medical Student Small Group Discussion
TopicsEvaluation of the Jaundiced Patient
How is extra-hepatic obstructive jaundice differentiated from other etiologies?
?Medical Student Small Group Discussion
TopicsEvaluation of the Jaundiced Patient
What are the etiologies of non
obstructive jaundice?
?Medical Student Small Group Discussion
TopicsEvaluation of the Jaundiced Patient
What are the etiologies of
obstructive jaundice?
?Medical Student Small Group Discussion
TopicsEvaluation of the Jaundiced Patient
What tests would you use to differentiate etiologies of
obstructive jaundice?
Medical Student Small Group Discussion Topics
A 36-year-old woman presents to the emergency room with a history of right upper quadrant pain, shaking chills, and jaundice.
Evaluation of the Jaundiced Patient
Medical Student Small Group Discussion Topics
Evaluation of the Jaundiced Patient
This pain came on suddenly six hours earlier and has been progressing. She took her temperature at home and it was 102. She vomited once at the onset of the pain. She has had intermittent episodes of epigastic and right upper quadrant pain after eating for the past six months. The pain always abated after thirty to sixty minutes. Her blood pressure is 110/60, her pulse 110, and her temperature 39 in the emergency room.
A 36-year-old woman with a history of right upper quadrant pain, shaking chills, and jaundice.
?Medical Student Small Group Discussion
TopicsEvaluation of the Jaundiced Patient
What is your differential diagnosis based on the patient’s history and
physical examination alone.
A 36-year-old woman with a history of right upper quadrant pain, shaking chills, and jaundice.
?Medical Student Small Group Discussion
TopicsEvaluation of the Jaundiced Patient
What laboratory studies, if any, would you order in this
patient?
A 36-year-old woman with a history of right upper quadrant pain, shaking chills, and jaundice.
Medical Student Small Group Discussion Topics
Evaluation of the Jaundiced Patient
Laboratory Results
A 36-year-old woman with a history of right upper quadrant pain, shaking chills, and jaundice.
WBC ct 18.7
Total Bilirubin 8.4
Direct Bilirubin 7.1
Lipase 15
Hgb 13.5
?Medical Student Small Group Discussion
TopicsEvaluation of the Jaundiced Patient
What imaging studies, if any, would you order in this
patient?
A 36-year-old woman with a history of right upper quadrant pain, shaking chills, and jaundice.
Medical Student Small Group Discussion Topics
Evaluation of the Jaundiced Patient
A 36-year-old woman with a history of right upper quadrant pain, shaking chills, and jaundice.
?Medical Student Small Group Discussion
TopicsEvaluation of the Jaundiced Patient
What is your diagnosis?
A 36-year-old woman with a history of right upper quadrant pain, shaking chills, and jaundice.
?Medical Student Small Group Discussion
TopicsEvaluation of the Jaundiced Patient
How would you manage this patient?
A 36-year-old woman with a history of right upper quadrant pain, shaking chills, and jaundice.
Medical Student Small Group Discussion Topics
A 74 year-old woman presents with a complaint of jaundice,
Evaluation of the Jaundiced Patient
Medical Student Small Group Discussion Topics
Evaluation of the Jaundiced Patient
Her husband noticed her jaundice two days before. She has had no specific pain but has noted post prandial epigastric discomfort, which has not responded to antacids. She has lost 20 pounds over the past three months, but is on a diet. Physical exam reveals an obviously icteric woman with a nontender globular mass in the right upper quadrant.
A 74 year-old woman presents with a complaint of jaundice,
?Medical Student Small Group Discussion
TopicsEvaluation of the Jaundiced Patient
A 74 year-old woman presents with a complaint of jaundice,
What is the nontender globular mass in the right upper quadrant?
?Medical Student Small Group Discussion
TopicsEvaluation of the Jaundiced Patient
A 74 year-old woman presents with a complaint of jaundice,
What is your differential diagnosis?
?Medical Student Small Group Discussion
TopicsEvaluation of the Jaundiced Patient
A 74 year-old woman presents with a complaint of jaundice,
What laboratory studies, if any, would you order in this
patient?
Medical Student Small Group Discussion Topics
Evaluation of the Jaundiced PatientA 74 year-old woman presents with a complaint of jaundice,
Among the laboratory studies ordered, results include:
WBC ct 8.4
Total Bilirubin 9.1
Direct Bilirubin 7.1
Lipase 16
Hgb 11.3
?Medical Student Small Group Discussion
TopicsEvaluation of the Jaundiced Patient
A 74 year-old woman presents with a complaint of jaundice,
What imaging studies, if any, would you order in this
patient?
Medical Student Small Group Discussion Topics
Evaluation of the Jaundiced PatientA 74 year-old woman presents with a complaint of jaundice,
?Medical Student Small Group Discussion
TopicsEvaluation of the Jaundiced Patient
A 74 year-old woman presents with a complaint of jaundice,
Based on these findings, how would you make a definitive
diagnosis?
?Medical Student Small Group Discussion
TopicsEvaluation of the Jaundiced Patient
A 74 year-old woman presents with a complaint of jaundice,
How would you manage this patient?
Medical Student Small Group Discussion Topics
A 19 year-old Hispanic woman presents with history of intermittent epigastric and right upper quadrant pain.
Evaluation of the Jaundiced Patient
Medical Student Small Group Discussion Topics
The patient speaks only Spanish.
Evaluation of the Jaundiced Patient
Medical Student Small Group Discussion Topics
Evaluation of the Jaundiced Patient
The pain occurs about 15 minutes after eating and lasts for one to two hours. This pain has been happening for about one month, two to three times a week, especially after eating French fries. She is 5 ft. 4 inches tall and weighs 130 pounds. She has never been pregnant and is currently taking birth control pills. Physical examination is normal. An ultrasound of gallbladder demonstrates multiple small stones.
A 19 year-old Hispanic woman presents with history of intermittent epigastric and right upper quadrant pain.
?Medical Student Small Group Discussion
TopicsEvaluation of the Jaundiced Patient
A 19 year-old Hispanic woman presents with history of intermittent epigastric and right upper quadrant pain.
What are the typical presenting symptoms, physical findings, radiological findings, and laboratory findings for each of the following:
• biliary colic• chronic cholecystitis• acute cholecystitis
?Medical Student Small Group Discussion
TopicsEvaluation of the Jaundiced Patient
A 19 year-old Hispanic woman presents with history of intermittent epigastric and right upper quadrant pain.
What is your diagnosis in this patient?
?Medical Student Small Group Discussion
TopicsEvaluation of the Jaundiced Patient
A 19 year-old Hispanic woman presents with history of intermittent epigastric and right upper quadrant pain.
What are the treatment options for this patient?
?Medical Student Small Group Discussion
TopicsEvaluation of the Jaundiced Patient
A 19 year-old Hispanic woman presents with history of intermittent epigastric and right upper quadrant pain.
What complications of gallstones might develop in this young female if the
gallbladder is not removed?
?Medical Student Small Group Discussion
TopicsEvaluation of the Jaundiced Patient
A 19 year-old Hispanic woman presents with history of intermittent epigastric and right upper quadrant pain.
What is the treatment for each of these potential
complications
?
