Challenger Medical Education Blog

42-year-old woman presents with abdominal pain for the last 2 days

Written by Med-Challenger | Jan 11, 2025 2:30:00 PM

A 42-year-old woman presents with abdominal pain for the last 2 days. She describes the pain as crampy and intermittent in the epigastric area, and she tells you that it is particularly worse after meals. She has a history of Roux-en-Y gastric bypass surgery that occurred 2 years ago.

Upon physical examination, she is afebrile. Her abdomen is soft and nontender with no masses.

Laboratory studies are shown below in the Table.

Laboratory study Value Normal range
WBC count 7,700/µL 3,200-9,800/µL
Hemoglobin 13.2 g/dL 11-14 g/dL
Platelets 215,000/µL 150,000-450,00/µL
Albumin 4.3 g/dL 3.5-5.5 g/dL
AST 334 U/L 5-52 U/L
ALT 282 U/L 7-46 U/L
Alkaline phosphatase 115 U/L 40-100 U/L
Total bilirubin 1.7 mg/dL 0.2-1.5 mg/dL
Amylase 42 U/L 30-110 U/L
Lipase 24 U/L 13-141 U/L

ALT, alanine transaminase; AST aspartate aminotransferase; WBC, white blood cell.

Ultrasonography of the abdomen demonstrates a normal-appearing liver, mild distension of the gallbladder with several stones in the fundus of the gallbladder, and no apparent wall thickening or pericholecystic fluid. The common bile duct is dilated to 1.3 cm.

What is the next most appropriate step in the management of this patient's condition?

  • Magnetic resonance cholangiopancreatography (MRCP)
  • Upper endoscopy with balloon dilation
  • Manometry of the sphincter of Oddi
  • Modified endoscopic retrograde cholangiopancreatography (ERCP)
  • Surgical referral for cholecystectomy

 

This question appears in Med-Challenger Family Medicine Exam Review with CME

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