Neet pg mcqs q7

A 50-year-old female is admitted for fever of 39 and “8 out of 10” abdominal pain. She complains of diarrhea that she describes as light colored stools that are foul smelling. On physical examination, she is noted to be jaundiced and have tenderness in her right upper quadrant of her abdomen. Labs are sent and are as follows:WBC: 15,000 with 10% bandsHgb: 13.3Platelets: 230,000Alk phos: 300Total bilirubin: 7.4Direct bilirubin: 6.3What is the most likely cause of this patient’s condition?

Ascending cholangitis
Cholecystitis
Choledocholithiasis
Gastroenteritis
Hereditary spherocytosis

Correct answer
Ascending cholangitis
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correct answer: A

The patient shows the classic signs of ascending cholangitis (fever, jaundice and right upper quadrant pain) called Charcot’s Triad. Ascending cholangitis is caused by chronic obstruction, usually by gallstones (choledocholithiasis, option C) that becomes infected. Fever and increased WBC counts are signs of infection that distinguish cholangitis from choledocholithiasis. Diarrhea of light colored stools that are foul smelling is steatorrhea (fatty stool) since bile is unable to enter the GI tract and digest fat.
Cholecystitis (option B) is an infection of the gallbladder which will present with fever and right upper quadrant pain (Murphy’s sign), but usually will not present with jaundice since bile flow is not obstructed. Although the gallbladder is obstructed due to a stone in the cystic duct, the common bile duct is clear and bile can flow directly from the liver to the GI tract.

Gastroenteritis (option D) will present with fever and diarrhea, but will usually present with vomiting, and there is rarely any jaundice or rise in bilirubin.

Hereditary spherocytosis (option E) is a autosomal dominant condition of the membrane of RBCs that causes hemolytic anemia. In hemolytic anemia, the lysis of RBCs will cause an increase in indirect bilirubin due the breakdown of hemoglobin. In this case, the jaundice is caused by direct bilibrubin and therefore cannot be attributed to a hemolytic anemia.