A 58-year-old man presents to the emergency department with 2 days of fever, chills, and progressively worsening right upper quadrant abdominal pain. He also reports nausea and vomiting. His medical history is significant for gallstones and type 2 diabetes mellitus. He takes metformin and glipizide. His temperature is 38.5°C (101.3°F), blood pressure is 100/60 mm Hg, pulse is 105/min, and respirations are 22/min. On physical examination, he appears ill and jaundiced, and there is tenderness to palpation in the right upper quadrant with a positive Murphy sign. Laboratory results show the following:
- Total bilirubin: 8.0 mg/dL
- Direct bilirubin: 5.8 mg/dL
- Alkaline phosphatase: 820 U/L
- Aspartate aminotransferase (AST): 110 U/L
- Alanine aminotransferase (ALT): 95 U/L
- Leukocytes: 18,500/mm3 with 82% neutrophils
Which of the following is the most likely finding on imaging of the abdomen?
- A) Biliary dilatation
- B) Gallbladder wall thickening and pericholecystic fluid
- C) Pancreatic edema and inflammation
- D) Short, annular strictures alternating with normal bile ducts
Author(s)
Kamand Khalaj
Editor(s)
Dr. Ted O'Connell
Dr. Raj Dasgupta
Last updated
Nov 03, 2024
