Case 356

Case 356

Medical History

Female patient, 57 years old, with intermittent epigastralgia for 30 days. The pain got worse and, three days ago, the patient initiated with nausea, vomiting, hyporexia and dark urine, but no discolored feces. Preserved general status, without fever, icteric (++/4+), distended and tense abdomen, painful palpation in the epigastrium. Laboratory tests: AST: 117 UI/L; ALT: 136 UI/L; Total Bilirubin: 3,0 mg/dL; Direct Bilirubin: 2,7 mg/dL; Amylase: 437 UI/L; Lipase: 551 UI/L; e CRP: 379 mg/dL. Ultrasound (US) of the abdomen: hydropic gallbladder; presence of biliary sludge. Requested computed tomography (CT) of the abdomen and pelvis.

According to the clinical history, laboratory tests, and images, what is the most likely diagnosis?

Test question

(SECRETARIA DE ESTADO DA SAÚDE PARAÍBA – 2017) Female patient, 42 years old, BMI 38 kg/m², diagnosed with cholelithiasis, was admitted to the emergency room with abdominal pain in the upper abdomen, band type, incoercible vomiting after having dinner in a pizzeria. On physical examination, she presents with upper abdominal pain, negative Murphy's sign, and jaundice (+/4+).

Check the alternative that presents the main diagnostic hypothesis, the complementary exam and the initial treatment for the patient above: