Case 393

Medical history

A 72-year-old female presented in the emergency room with right hypochondrium (RH) pain for the past 18 hours, initially with cramps and later continuously, accompanied by vomits. Previously diagnosed with arterial hypertension, type 2 diabetes and hypertriglyceridemia. No history of etilism. Good general condition, without jaundice and afebrile. Flat abdomen, flaccid, painful on light and deep palpation of the RH, interrupting deep inspiration during palpation. An upper abdominal ultrasound was ordered (images 1 and 2).

Considering the clinical features and the images above, which diagnosis is the most likely?

Test question

UNIVERSITARY HOSPITAL PRESIDENTE DUTRA - MA (2016). A 40-year-old woman, obese, multiparous, with history of epigastric pain radiating to righ hypocondrium for the past 2 years, associated with nausea, vomiting and isolated episodes of fever. Went through abdominal ultrasound 1 year ago, which evidenced cholelithiasis (with small and medium calculus). Reporting upper abdominal pain started 3 days ago, radiating to the back, choluria, jaundice, fever and chills. Submitted to cholangio resonance, which evidenced cholelithiasis, choledocholithiasis (3 bile duct calculus) and choleduchus 14mm dilated.

Regarding the written case, point out the INCORRECT alternative.

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