A 46-year-old woman was admitted yesterday with epigastric pain and a serum lipase of 3,400 U/L (<60). Ultrasound showed multiple gallbladder stones and a common bile duct of 11 mm. Overnight she has developed rigors; her temperature is 39.1 °C, pulse 118/min and blood pressure 96/58 mmHg despite fluids. Bilirubin has risen from 48 to 112 µmol/L (<20), alkaline phosphatase is 510 U/L (30–110), and white cell count is 21 × 10⁹/L. She is confused.
Which one of the following is the most appropriate next step in management?
Keep going with ten more like this one.
Practise moreMore from Gastroenterology and Hepatology
See allA 26-year-old man born in Vietnam who migrated to Australia at age 10 attends for a pre-employment medical. He is well. Blood tests show: hepatitis B surface an…
Pre-internship · middle twist
A 29-year-old woman asks whether she has coeliac disease. For three years she had bloating, loose stools and tiredness; four months ago she removed gluten from…
Clinical rotations · middle twist
A 34-year-old woman describes 18 months of intermittent difficulty swallowing. From the beginning both liquids and solids have been affected, and it is worse wh…
Clinical rotations · common
A 56-year-old man with alcohol-related cirrhosis presents with profuse vomiting of blood. He is agitated, intermittently drowsy and repeatedly coughing while bl…
Clinical rotations · common
A 61-year-old man is brought to the emergency department after fainting and passing a large amount of bright red blood. His blood pressure is now 102/70 mmHg af…
Clinical rotations · middle twist