11/21/23, 10:38 AM

Questions
What is the most likely diagnosis?

Based on the symptoms described (intermittent colicky pain in the right upper quadrant, bloating, nausea, light-colored stools, and yellowing of the skin), the most likely diagnosis is
gallstones obstructing the common bile duct, leading to choledocholithiasis.

The intermittent colicky pain in the right upper quadrant a!er eating, along with the jaundice (yellowing of the skin) and light-colored stools (acholic stools), are indicative of an
obstruction in the common bile duct. This obstruction can be caused by gallstones, which prevent the normal flow of bile from the liver to the small intestine, leading to these symptoms.

It is important for the patient to undergo further evaluation, such as imaging studies (like ultrasound or MRI) and liver function tests, to confirm the diagnosis and determine the
appropriate treatment, which may include surgery to remove the gallstones or endoscopic procedures to remove the stones and relieve the obstruction.

Enter Answer

What is the anatomic basis for the clinical condition?

In the case of choledocholithiasis, gallstones (solid particles that form in the gallbladder) can travel out of the gallbladder and become lodged in the common bile duct. When this
happens, several issues can arise:

Obstruction: Gallstones in the CBD obstruct the flow of bile, preventing it from reaching the small intestine. This obstruction leads to a backup of bile in the liver and causes jaundice
(yellowing of the skin and eyes) due to the accumulation of bilirubin, a component of bile, in the bloodstream.

Pain: The intermittent colicky pain experienced by the patient is caused by the obstruction of the CBD. The pain occurs as the gallbladder contracts and attempts to push bile past the
obstructed duct.

Acholic Stools: Since bile, which gives stools its normal brown color, is not reaching the intestine properly, stools become pale or clay-colored (acholic).

Enter Answer
Answer to Case 19: Gallstones

Summary: A 42-year-old woman presents with intermittent colicky RUQ abdominal pain shortly a!er eating, that lasts for
about 30 min. It is associated with bloating, nausea, and a 2-day history of acholic stools and icterus.

https://casefiles.mhmedical.com/CaseContent.aspx?gbosID=219187&gbosContainerID=62&viewByNumber=false&groupid=0 Page 1 of 2
 11/21/23, 10:38 AM

Most likely diagnosis: Gallstones

Anatomical basis for condition: Bile duct obstruction, probably by gallstones

Clinical Correlation

This middle-aged woman has the typical symptoms of biliary colic, which is intermittent crampy abdominal pain in the
epigastric region of the RUQ, sometimes radiating to the right shoulder. These symptoms typically appear a!er meals,
particularly fatty meals. The more concerning signs are the light-colored stools (acholic) and jaundice (icterus). Gallstones
(cholelithiasis) are precipitated bile salts in the gallbladder, which may produce inflammation of the gallbladder (cholecystitis).
Stones can pass into the cystic duct and into the common bile duct. Since the common bile duct is formed by the union of the
cystic and common hepatic ducts, obstruction of the common bile duct prevents bilirubin produced in the liver from reaching
the small intestines. The stools thus lack this pigment. As a secondary result of the obstruction, serum bilirubin is elevated, and
precipitates in the skin, resulting in the yellow tint. Ultrasound can o!en make the initial diagnosis. Removal of a common bile
duct stone can be performed by upper GI endoscopy through the ampulla of Vater or surgically.

Save Answers Email Answers Return to Top of Results Print Results

Show Answers

McGraw Hill
Copyright © McGraw Hill
All rights reserved.
Your IP address is 181.214.150.152
Terms of Use • Privacy Policy • Notice • Accessibility • Browser Support

Access Provided by: Xavier University School of Medicine

Silverchair
Back To Top

https://casefiles.mhmedical.com/CaseContent.aspx?gbosID=219187&gbosContainerID=62&viewByNumber=false&groupid=0 Page 2 of 2