Question

question 35 (mandatory) (1 point)
a 27 - year - old female patient presents with intense right upper quadrant pain with nausea and vomiting. physical exam reveals jaundice and a fever of 101f. she states that her pain is increased after eating fatty meals. what is the most likely diagnosis and confirmatory test?
a) pancreatitis; ct
b) cirrhosis; biopsy
c) gallstones; ultrasound
d) hepatitis; hep panel

Explanation:

• Gallstones:
• Symptoms: Right upper quadrant pain (which is a common location for gallbladder - related pain as the gallbladder is in the right upper abdomen), pain increased after eating fatty meals (fatty meals stimulate gallbladder contraction to release bile, and if there are gallstones, this can cause more pain). Nausea, vomiting, jaundice (if a gallstone blocks the common bile duct, it can lead to conjugated bilirubin backing up into the bloodstream causing jaundice), and fever (suggests possible inflammation or infection, such as cholecystitis which can occur with gallstones).
• Diagnostic test: Ultrasound is the first - line and highly sensitive test for gallstones. It can visualize the gallbladder, detect the presence of stones (as they appear as hyperechoic structures with shadowing), and assess the gallbladder wall thickness (which may be thickened in cholecystitis).
• Pancreatitis: Usually presents with epigastric pain that may radiate to the back. While nausea and vomiting can occur, jaundice is less common unless there is a common bile duct obstruction (but the pain location and typical association with fatty meals for gallstones make it less likely here). CT is used for pancreatitis, but the clinical picture points more to gallstones.
• Cirrhosis: Typically has a more chronic course with symptoms like ascites, spider angiomas, etc. Biopsy is used for diagnosis, but the acute presentation with the described symptoms is not typical for cirrhosis.
• Hepatitis: May present with fatigue, anorexia, right upper quadrant pain. A Hep Panel (liver function tests and viral markers) is used. However, the association with fatty - meal - induced pain and the presence of possible biliary obstruction (jaundice) makes gallstones more likely.

Answer:

C. Gallstones; ultrasound