Question

48-Year-Old Female with GallstonesMs. Burton, 48, presents at the clinic complaining of abdominal pain. She is a middle-aged woman, overweight, pale and sweating, with jaundice (yellowish skin and sclerae). Her heart rate is 102 beats/ min and BP is 145/98 mm Hg. She describes the pain as "severe" and "steady" over the past night, accompanied by nausea and vomiting. She sits leaning forward and indicates that the pain is in the epigastric region radiating up to the tip of the right shoulder. Ms. Burton's medical history shows that she has had several episodes of biliary colic (pain caused by gallstones going through the bile duct). She says her current pain is "sort of like that, but it's lasted longer." She says her last meal was a seven-cheese pizza the previous night, and that the pain began 3−4 hours after eating. She denies drinking or smoking.

Which of the following correctly interprets these results?
A. The presence of pancreatic enzymes in the blood is good news because it indicates that the pancreas is still functioning.
B. The location of the gallstone is a problem because it blocks bile from entering the duodenum and forces bile up into the pancreas.
C. The dilation of the ducts is good news because that will make it easier for gallstones to pass.
D. The location of the gallstone is good news because it shows that the stone has almost passed into the duodenum.

Answer 1

The correct interpretation is that Ms. Burton's symptoms indicate that the gallstone is causing a blockage of the bile duct, which can lead to complications such as pancreatitis. The dilation of the ducts or the presence of pancreatic enzymes in the blood are signs of pathology, not good news.answer is option D.

Step-by-step explanation:

The presence of gallstones and jaundice in Ms. Burton suggests a potential obstruction of the bile duct. Jaundice occurs when bilirubin, a bile pigment, accumulates in the blood due to a blocked bile duct, which prevents bile from being excreted normally. The history of biliary colic and current symptoms including pain in the epigastric region radiating to the right shoulder after a fatty meal indicates that a gallstone is likely causing a blockage, and this is a complication that requires medical intervention. An increased heart rate (tachycardia) and elevated blood pressure (hypertension) are also concerning signs that need immediate medical attention.

The correct interpretation of Ms. Burton's signs and symptoms points towards option B: The location of the gallstone is a problem because it blocks bile from entering the duodenum and forces bile up into the pancreas. This blockage can lead to complications such as pancreatitis, which is an inflammation of the pancreas and can occur when a gallstone blocks the outflow of pancreatic enzymes, causing the enzymes to damage the pancreas itself.

Statements such as the presence of pancreatic enzymes in the blood being good news, or the dilation of the ducts being beneficial, are incorrect (option A and C). The location of the gallstone is not good news just because it is near the duodenum (option D); if it is causing symptoms, it indicates a problem that may require medical intervention or even surgical removal of the gallstone or gallbladder.