Patient Case
A 50-year old woman presents to the emergency room with a 24-hour history of
abdominal pain that began approximately one hour after a reportedly large dinner. The
pain began as a dull ache in the epigastrium but then localized in the right upper
quadrant. She reports some nausea but no vomiting. Since her arrival to the ER, the
pain has decreased significantly. She admits to a number of previous episodes in the
recent past. Her medical history is significant for type II diabetes mellitus. On physical
examination, her temperature is 38.1 C (99 F). Remaining vital signs are normal. The
abdomen is nondistended with minimal tenderness in the RUQ. The liver, rectal and
pelvic examinations are normal. CBC reveals a WBC count of 13,000/mm. Serum
chemistry studies demonstrate total bilirubin 1.8 mg/dL, direct bilirubin 0.6 mg/dL,
alkaline phosphatase 140 U/L, AST 45 U/L and ALT 30 U/L. Ultrasonography of the
RUQ demonstrates stones in the gallbladder, a thickened gallbladder wall, and a
common bile duct diameter of 4.0 mm.
Discussion Questions
1. What is the most likely diagnosis?
2. What is the best therapy?
3. What are the complications associated with the disease process?
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