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

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Presentation on theme: "Medical Student Small Group Discussion Topics Evaluation of the Jaundiced Patient."— Presentation transcript:

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

2 Suggested Reading Current Diagnosis & Treatment: Surgery, Thirteenth Edition Edited by Gerard M. Doherty Copyright © 2010 by The McGraw-Hill Companies, Inc. Chapter 25. Biliary Tract Schwartz's Principles of Surgery, 9e 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. Chapter 32. Gallbladder and the Extrahepatic Biliary System Current Diagnosis and Treatment: Surgery

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

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

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

9 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 A 36-year-old woman presents to the emergency room with a history of right upper quadrant pain, shaking chills, and jaundice. Evaluation of the Jaundiced Patient

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

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

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

15 Medical Student Small Group Discussion Topics Evaluation of the Jaundiced Patient Laboratory Results A 36-year-old woman with a history of right upper quadrant pain, shaking chills, and jaundice. WBC ct18.7 Total Bilirubin8.4 Direct Bilirubin7.1 Lipase15 Hgb13.5

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

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 What is your diagnosis? A 36-year-old woman with a history of right upper quadrant pain, shaking chills, and jaundice.

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

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

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

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 ct8.4 Total Bilirubin9.1 Direct Bilirubin7.1 Lipase16 Hgb11.3

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 A 19 year-old Hispanic woman presents with history of intermittent epigastric and right upper quadrant pain. Evaluation of the Jaundiced Patient

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

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

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 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 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 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

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