1. Medical Student Small Group Discussion Topics
Evaluation of the Jaundiced Patient

2. Suggested Reading Current Diagnosis and Treatment: Surgery
Chapter 25. Biliary Tract
Schwartz's Principles of Surgery, 9e
Chapter 32. Gallbladder and the Extrahepatic Biliary System
Current Diagnosis & Treatment: Surgery, Thirteenth Edition
Edited by Gerard M. Doherty
Copyright © 2010 by The McGraw-Hill Companies, Inc.
Schwartz's Principles of Surgery, 9e F. Charles Brunicardi, Dana K. Andersen, Timothy R. Billiar, David L. Dunn, John G. Hunter, Jeffrey B. Matthews, Raphael E. Pollock
Copyright © 2010, 2005, 1999, 1994, 1989, 1984, 1979, 1974, 1969 by The McGraw-Hill Companies, Inc.

3. ? Medical Student Small Group Discussion Topics
Evaluation of the Jaundiced Patient ?
Outline the anatomy and embryology of the bile ducts, gallbladder, and pancreas.

4. ? Explain the mechanism of gall stone formation
Medical Student Small Group Discussion Topics
Evaluation of the Jaundiced Patient ?
Explain the mechanism of gall stone formation

5. ? What types of gallstones can be formed?
Medical Student Small Group Discussion Topics
Evaluation of the Jaundiced Patient ?
What types of gallstones can be formed?

6. ? What factors predispose to the formation of gallstones?
Medical Student Small Group Discussion Topics
Evaluation of the Jaundiced Patient ?
What factors predispose to the formation of gallstones?

7. ? Medical Student Small Group Discussion Topics
Evaluation of the Jaundiced Patient ?
How is extra-hepatic obstructive jaundice differentiated from other etiologies?

8. ? What are the etiologies of non obstructive jaundice?
Medical Student Small Group Discussion Topics
Evaluation of the Jaundiced Patient ?
What are the etiologies of non obstructive jaundice?

9. ? What are the etiologies of obstructive jaundice?
Medical Student Small Group Discussion Topics
Evaluation of the Jaundiced Patient ?
What are the etiologies of obstructive jaundice?

10. ? Medical Student Small Group Discussion Topics
Evaluation of the Jaundiced Patient ?
What tests would you use to differentiate etiologies of obstructive jaundice?

11. Medical Student Small Group Discussion Topics
Evaluation of the Jaundiced Patient
A 36-year-old woman presents to the emergency room with a history of right upper quadrant pain, shaking chills, and jaundice.

12. Medical Student Small Group Discussion Topics
Evaluation of the Jaundiced Patient
A 36-year-old woman with a history of right upper quadrant pain, shaking chills, and jaundice.
This pain came on suddenly six hours earlier and has been progressing. She took her temperature at home and it was 102. She vomited once at the onset of the pain. She has had intermittent episodes of epigastic and right upper quadrant pain after eating for the past six months. The pain always abated after thirty to sixty minutes. Her blood pressure is 110/60, her pulse 110, and her temperature 39 in the emergency room.

13. ? Medical Student Small Group Discussion Topics
Evaluation of the Jaundiced Patient ?
A 36-year-old woman with a history of right upper quadrant pain, shaking chills, and jaundice.
What is your differential diagnosis based on the patient’s history and physical examination alone.

14. ? Medical Student Small Group Discussion Topics
Evaluation of the Jaundiced Patient ?
A 36-year-old woman with a history of right upper quadrant pain, shaking chills, and jaundice.
What laboratory studies, if any, would you order in this patient?

15. Medical Student Small Group Discussion Topics
Evaluation of the Jaundiced Patient
A 36-year-old woman with a history of right upper quadrant pain, shaking chills, and jaundice.
Laboratory Results
WBC ct
18.7
Total Bilirubin
8.4
Direct Bilirubin
7.1
Lipase 15
Hgb
13.5

16. ? Medical Student Small Group Discussion Topics
Evaluation of the Jaundiced Patient ?
A 36-year-old woman with a history of right upper quadrant pain, shaking chills, and jaundice.
What imaging studies, if any, would you order in this patient?

17. Medical Student Small Group Discussion Topics
Evaluation of the Jaundiced Patient
A 36-year-old woman with a history of right upper quadrant pain, shaking chills, and jaundice.

18. ? Medical Student Small Group Discussion Topics
Evaluation of the Jaundiced Patient ?
A 36-year-old woman with a history of right upper quadrant pain, shaking chills, and jaundice.
What is your diagnosis?

19. ? Medical Student Small Group Discussion Topics
Evaluation of the Jaundiced Patient ?
A 36-year-old woman with a history of right upper quadrant pain, shaking chills, and jaundice.
How would you manage this patient?

20. Medical Student Small Group Discussion Topics
Evaluation of the Jaundiced Patient
A 74 year-old woman presents with a complaint of jaundice,

21. Medical Student Small Group Discussion Topics
Evaluation of the Jaundiced Patient
A 74 year-old woman presents with a complaint of jaundice,
Her husband noticed her jaundice two days before. She has had no specific pain but has noted post prandial epigastric discomfort, which has not responded to antacids. She has lost 20 pounds over the past three months, but is on a diet. Physical exam reveals an obviously icteric woman with a nontender globular mass in the right upper quadrant.

22. ? Medical Student Small Group Discussion Topics
Evaluation of the Jaundiced Patient ?
A 74 year-old woman presents with a complaint of jaundice,
What is the nontender globular mass in the right upper quadrant?

23. ? Medical Student Small Group Discussion Topics
Evaluation of the Jaundiced Patient ?
A 74 year-old woman presents with a complaint of jaundice,
What is your differential diagnosis?

24. ? Medical Student Small Group Discussion Topics
Evaluation of the Jaundiced Patient ?
A 74 year-old woman presents with a complaint of jaundice,
What laboratory studies, if any, would you order in this patient?

25. Medical Student Small Group Discussion Topics
Evaluation of the Jaundiced Patient
A 74 year-old woman presents with a complaint of jaundice,
Among the laboratory studies ordered, results include:
WBC ct
8.4
Total Bilirubin
9.1
Direct Bilirubin
7.1
Lipase 16
Hgb
11.3

26. ? Medical Student Small Group Discussion Topics
Evaluation of the Jaundiced Patient ?
A 74 year-old woman presents with a complaint of jaundice,
What imaging studies, if any, would you order in this patient?

27. Medical Student Small Group Discussion Topics
Evaluation of the Jaundiced Patient
A 74 year-old woman presents with a complaint of jaundice,

28. ? Medical Student Small Group Discussion Topics
Evaluation of the Jaundiced Patient ?
A 74 year-old woman presents with a complaint of jaundice,
Based on these findings, how would you make a definitive diagnosis?

29. ? Medical Student Small Group Discussion Topics
Evaluation of the Jaundiced Patient ?
A 74 year-old woman presents with a complaint of jaundice,
How would you manage this patient?

30. Medical Student Small Group Discussion Topics
Evaluation of the Jaundiced Patient
A 19 year-old Hispanic woman presents with history of intermittent epigastric and right upper quadrant pain.

31. Medical Student Small Group Discussion Topics
Evaluation of the Jaundiced Patient
The patient speaks only Spanish.

32. Medical Student Small Group Discussion Topics
Evaluation of the Jaundiced Patient
A 19 year-old Hispanic woman presents with history of intermittent epigastric and right upper quadrant pain.
The pain occurs about 15 minutes after eating and lasts for one to two hours. This pain has been happening for about one month, two to three times a week, especially after eating French fries. She is 5 ft. 4 inches tall and weighs 130 pounds. She has never been pregnant and is currently taking birth control pills. Physical examination is normal. An ultrasound of gallbladder demonstrates multiple small stones.

33. Medical Student Small Group Discussion Topics
Evaluation of the Jaundiced Patient ?
A 19 year-old Hispanic woman presents with history of intermittent epigastric and right upper quadrant pain.
What are the typical presenting symptoms, physical findings, radiological findings, and laboratory findings for each of the following:
biliary colic
chronic cholecystitis
acute cholecystitis

34. ? What is your diagnosis in this patient?
Medical Student Small Group Discussion Topics
Evaluation of the Jaundiced Patient ?
A 19 year-old Hispanic woman presents with history of intermittent epigastric and right upper quadrant pain.
What is your diagnosis in this patient?

35. ? What are the treatment options for this patient?
Medical Student Small Group Discussion Topics
Evaluation of the Jaundiced Patient ?
A 19 year-old Hispanic woman presents with history of intermittent epigastric and right upper quadrant pain.
What are the treatment options for this patient?

36. Medical Student Small Group Discussion Topics
Evaluation of the Jaundiced Patient ?
A 19 year-old Hispanic woman presents with history of intermittent epigastric and right upper quadrant pain.
What complications of gallstones might develop in this young female if the gallbladder is not removed?

37. ? What is the treatment for each of these potential complications
Medical Student Small Group Discussion Topics
Evaluation of the Jaundiced Patient ?
A 19 year-old Hispanic woman presents with history of intermittent epigastric and right upper quadrant pain.
What is the treatment for each of these potential complications

38. ?