Gall bladder and biliary tract conditions

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 commo…

Pre-internship · middle twist

A 42-year-old woman has 18 months of fatigue, pruritus and intermittent discomfort beneath the right costal margin. Alkaline phosphatase is 410 U/L (30–110), al…

Clinical rotations · middle twist

A 79-year-old woman presents with four days of intermittent cramping abdominal pain, vomiting and increasing abdominal distension. She has no history of abdomin…

Clinical rotations · common

A 34-year-old man with established primary sclerosing cholangitis develops worsening pruritus and jaundice over six weeks, with a 5 kg weight loss. His bilirubi…

Clinical rotations · middle twist

A 42-year-old man presents with several months of pruritus followed by yellowing of the eyes. He has ulcerative colitis, an alkaline phosphatase of 680 U/L (30–…

Clinical rotations · common

A 45-year-old woman is admitted with epigastric pain radiating to the back and a serum lipase of 2400 U/L (<60). Ultrasound shows multiple small stones in the g…

Clinical rotations · middle twist

A 68-year-old woman presents with two days of constant right upper quadrant and epigastric pain. Overnight she had two episodes of violent, uncontrollable shaki…

Clinical rotations · common