Clinical Scenarios: Disorders of the biliary system
1. A 50 year old long standing sufferer of ulcerative colitis attends the outpatient clinic with a 6 month history of weight loss and generalised pruritus. He is clinically jaundiced with a bilirubin concentration of 94 μ mol/L and an elevated ALP of 250 IU/L. MRCP reveals the presence of multifocal strictures of the intrahepatic and extrahepatic bile ducts
2. A 32 year old woman with known gallstones presents with a 36 hours history of RUQ pain and anorexia. On examination there is no evidence of jaundice or pallor. She is pyrexial and tachycardic and Murphy’s sign positive. Her WCC is elevated but all other blood and radiological investigations are normal.
1. A 50 year old long standing sufferer of ulcerative colitis attends the outpatient clinic with a 6 month history of weight loss and generalised pruritus. He is clinically jaundiced with a bilirubin concentration of 94 μ mol/L and an elevated ALP of 250 IU/L. MRCP reveals the presence of multifocal strictures of the intrahepatic and extrahepatic bile ducts
2. A 32 year old woman with known gallstones presents with a 36 hours history of RUQ pain and anorexia. On examination there is no evidence of jaundice or pallor. She is pyrexial and tachycardic and Murphy’s sign positive. Her WCC is elevated but all other blood and radiological investigations are normal.
Select the diagnosis from the list of options given below:
· Acalculus cholecystitis
· Acute cholangitis
· Acute cholecystitis
· Biliary stricture
· Carcinoma of the gallbladder
· Cholagiocarcinoma
· Chronic cholecystitis
· Gallstones
· Empyema of the gallbladder
· Primary biliary cirrhosis
· Primary sclerosing cholangitis
· Acalculus cholecystitis
· Acute cholangitis
· Acute cholecystitis
· Biliary stricture
· Carcinoma of the gallbladder
· Cholagiocarcinoma
· Chronic cholecystitis
· Gallstones
· Empyema of the gallbladder
· Primary biliary cirrhosis
· Primary sclerosing cholangitis