Internal medicine 4 course Day 8 sem 2nd

Which one of the following statements is incorrect in regard to stones in the gallbladder?

A 40-year-old woman with diabetes and chronic kidney disease present to the clinic for follow-up after an abdominal ultrasound revealed incidental cholelithiasis without inflammation. The ultrasound revealed two stones, which were less than 5 mm in size. The patient's kidneys were normal. The patient denies experiencing abdominal pain, nausea, or vomiting. She has not had cholecystitis in the past. Of the following, which is the best step to take next in the treatment of this patient?  

A 45-year-old woman presents to the emergency department complaining of right upper quadrant pain, fever, and nausea of 8 hours' duration. On examination, the patient is found to have right upper quadrant tenderness. Laboratory evaluation reveals leukocytosis and a bilirubin level of 2.5 mg/dl. Which of the following tests is the most accurate method of confirming the clinical diagnosis of acute cholecystitis?

A 54-year-old man with diabetes and peripheral vascular disease presents to the emergency department with complaints of right upper quadrant abdominal pain of 2 days' duration. On physical examination, the patient appears ill. He has hypotension, fever, and right upper quadrant pain. Laboratory evaluation reveals leukocytosis and a bilirubin level of 3.0 mg/dl. In addition, aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels are three times the upper limit of normal. Ultrasound reveals gas in the gallbladder. You make a diagnosis of emphysematous cholecystitis. Which of the following is the most likely infectious agent in this patient?

A 60-year-old woman with diabetes, severe congestive heart failure, and emphysema presented to clinic complaining of occasional right upper quadrant pain, flatulence, and heartburn. She had been experiencing these symptoms for a period of 1 year. At the time, her physical examination was normal, as was her laboratory evaluation. After undergoing an abdominal ultrasound, she was diagnosed as having chronic cholecystitis, with gallbladder stones and a thickened gallbladder wall. She was referred to surgery. However, the surgeon determined that she was a poor surgical candidate. Today she presents to your clinic with the same persistent complaints. What is the best possible treatment option for this patient?

A 58-year-old man with altered mental status is brought to the emergency department by the emergency medical service. No history can be obtained. On physical examination, the patient is found to have fever, hypotension, jaundice, and right upper quadrant pain with guarding. Laboratory evaluation reveals leukocytosis, an alkaline phosphatase level of 180 U/L, and a bilirubin level of 5 mg/dl. The patient is diagnosed as having cholangitis. For this patient, which of the following imaging modalities has both diagnostic and therapeutic utility?

A 48-year-old African American woman presents to theemergency department with anorexia, nausea, vomiting,and abdominal pain over the last week. The pain wasinitially in the midepigastric area but has shifted to the rightupper quadrant. This most recent episode of pain hasprogressed over the last 5 hours. She has no past medicalhistory, takes no medications, and has never been pregnant.Her temperature is 38.3° C (100.9° F), blood pressureis 135/80 mm Hg, and pulse is 105 beats/min. She isanicteric and has diminished skin turgor. Her abdomen issoft, and she has voluntary guarding and inspiratory arrestwhen palpating the right upper quadrant. Pelvic and rectalexaminations are unremarkable. Her leukocyte count is14,000/cumm with a left shift, direct bilirubin is 2.4 mg/dL,alkaline phosphatase is 250 U/L, and the remainder of herliver function tests, electrolytes, and pancreatic enzymes arewithin normal limits. Which of the following tests is warranted to confi rm a diagnosis of acute cholecystitis in this patient?

A 57-year-old man presents to the emergency departmentwith a 3-day history of nausea, vomiting, right upperquadrant pain, and fevers. In the emergency department, histemperature is 38.7° C (101.7° F), pulse is 120 beats/min, andblood pressure is 90/60 mm Hg. He is jaundiced and drowsybut arousable and oriented to person only. There is markedtenderness in the right upper quadrant and an inspiratorypause with palpation but no organomegaly or reboundtenderness. Bowel sounds are diminished, and the stoolexamination did not show occult blood. His leukocyte countis 23,000, with 80% neutrophils and 12% band forms.Hemoglobin is 19 g/dL, total bilirubin is 3.8 mg/dL, directbilirubin is 3.0 mg/dL, alkaline phosphatase is 295 U/L,aspartate aminotransferase (AST) is 210 U/L, alanineaminotransferase (ALT) is 232 U/L, and serum creatinine is2.1 mg/dL. A transabdominal sonogram shows multiplestones in the gallbladder; diffuse gallbladder wall thickening,and 11 mm of common bile duct dilation. After initiationof intravenous fl uids and empiric antibiotics, the patientis transferred to the intensive care unit for furthermanagement. Which one of the following treatment options is most benefi cial in this patient?

A 52-year-old obese female patient presents to clinic withcomplaints of heartburn, bloating, and mild postprandialmidepigastric fullness. She has painful episodes associatedwith eating two to three times per month. Her past medicalhistory is signifi cant for cholelithiasis, polycystic ovaries,and depression. She is currently only taking acetaminophenon an as-needed basis for her symptoms. She is afebrile,and her physical examination is signifi cant for an obese, softabdomen without organomegaly, masses, or tenderness.Pelvic and rectal examinations are normal. An abdominal x-ray (KUB) shows a normal bowel gas pattern and acalcifi ed gallbladder. Serum electrolytes, creatinine, liverfunction tests, lipase, and a complete blood count are allwithin normal limits. A diagnosis of chronic cholecystitis ismade. In addition to obtaining a transabdominal sonogram, what is the treatment of choice to reduce symptoms for this patient?

A 68-year-old diabetic man presents to clinic to follow up a recent sonogram. He has a history of an infrarenal abdominal aortic aneurysm (AAA) and underwent recent screening. A total abdominal sonogram shows an infrarenal AAA with a maximal diameter of 3.3 cm and no evidence of dissection. Incidentally, several cholelithiases were noted within a nondistended gallbladder. He has no abdominal pain, nausea, vomiting, bloating, jaundice, or pruritus. What is the best management for this patient's biliary disease?

A 43-year-old female presents to clinic with postprandial nausea and vomiting. Occasionally, she develops midepigastric pain that radiates to the right shoulder. These painful episodes last between 4 and 6 hours and resolve spontaneously. She does not have any pruritus, jaundice, weight changes, or changes in stool caliber. She has a history of cholecystitis treated by cholecystectomy 3 years previously, hypertension, and gastroesophageal refl ux disease. She currently takes omeprazole 20 mg daily and lisinopril 10 mg daily. She does not smoke or drink alcoholic beverages. On physical examination, her abdomen is soft and nondistended, and there is diffuse tenderness to palpation. There are no masses or organomegaly. Hemoccult is negative. Her leukocyte count is 6,000 with a normal differential, hemoglobin is 13 g/dL, total bilirubin is 1.8 mg/dL, direct bilirubin is 1.0 mg/dL, alkaline phosphatase is 170 U/L, AST is 110 U/L, ALT is 88 U/L, and serum creatinine is 0.6 mg/dL. CT of the abdomen with intravenous contrast reveals a normalappearing liver, pancreas, and gallbladder fossa but dilation of the common bile duct without visualization of biliary tract stones. What is the next best step in diagnosis of sphincter of Oddi dysfunction (SOD) in this patient?

A feature of healthy gallbladder on laparotomy are:

True about gallstones:

Investigation of choice in acute cholecystitis

Acalculous cholecystitis is caused by: