| Symptoms
& History
Physical
Findings
Stop
& Think
Lab
and X-Ray
Differential
Diagnosis
The
Disease
Treatment
Conclusions
Quiz
& Evaluation |
|
Mr.
Stein's history, abdominal ultrasound and labs are adding up to something
seriously wrong with his liver and/or biliary tree.
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History and physical are consistent
with acute gallbladder disease. Location of pain,
abdominal tenderness, nausea.
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Scleral
icterus. Elevated bilirubin.
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Abdominal ultrasound shows a
gallstone in the gallbladder and dilated biliary tree. Is
there one stuck further down?
-
Chemistry values are off. Pattern
suggests liver parenchymal and biliary disease. (Which lab value is telling
us what part of the liver is involved?)
-
CBC suggests an acute inflammatory
process. What tells us this?
Important clinical questions
for now are:
-
How long will he remain symptomatic,
continue to have elevated liver enzymes and bilirubin if a stone has already
passed?
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If it hasn't passed, where the
heck is it and what else can go wrong?
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