Question

A 67-year-old woman presents complaining of dark urine. Over several months she has had increased fatigue and weight loss. There has not been any fever or night sweats. On physical examination, she has scleral icterus and mild jaundice. Her abdomen is soft, non-distended with a palpable mass in the right upper quadrant that is non-tender. Her laboratory values are notable for a total bilirubin of 6.4 mg/dl and a direct bilirubin of 5.0 mg/dl. What is your imaging study of choice?

a) Abdominal CT scan
b) Endoscopic retrograde cholangiopancreatography (ERCP)
c) Right upper quadrant ultrasound
d) Upper GI series

Answer 1

The right upper quadrant ultrasound is the imaging study of choice for a 67-year-old woman with dark urine, fatigue, weight loss, scleral icterus, mild jaundice, and a palpable mass in the right upper quadrant.

Step-by-step explanation:

The imaging study of choice for this patient is a Right upper quadrant ultrasound.

This is because the patient's symptoms and physical examination findings suggest an obstructive jaundice, which is commonly caused by gallstones or a mass in the biliary tree. A Right upper quadrant ultrasound is a non-invasive imaging modality that can help identify the cause of the obstruction, such as gallstones or a tumor.

Other imaging studies like an Abdominal CT scan or an Endoscopic retrograde cholangiopancreatography (ERCP) may also be used depending on the specific clinical scenario, but a Right upper quadrant ultrasound is the initial imaging study of choice.