Case

A 47 year old patient is brought to the ER complaining of pain in their upper right abdominal quadrant. You note that the patient has a slight fever and yellow tint to their eyes. The patient reports their urine is a dark coloration and their stool light tan in color.  The patient first noticed the symptoms approximately a week ago.

Question 1/2 - What further studies would you initially perform to confirm or rule out your diagnosis?

Click on your selected option(s) below  (correct = 1, over-thinking = 2+)

Case Complete

Incorrect. CT has limited ability to identify gallstones and less resolution on soft tissue making it suboptimal for cancers as well.

Incorrect. MRI, while effective at detecting gallstones as well as cancers, is more expensive and time consuming. It could be a secondary study if additional information is needed, but it would not be the best initial study to perform.

Correct!  Since we have a high suspicion of gallstones causing obstruction, the frontline study for stones is ultrasound. Sensitivity and selectivity are excellent with a positive observation of stones definitive for your diagnosis.

Incorrect. X-Ray has limited ability to identify gallstones and even with multiple views, somewhat limited 3-dimensional information compared to other methods.

Incorrect.  While you might undertake a physical examination in this patient it would not be diagnostic of gallstones, since those cannot be palpated.