QuestionSBA
QuestionChoice
Incorrect - The location of pain, in this case, does not correlate with that expected in appendicitis, which begins centrally and then migrates to the right iliac fossa. Appendicitis typically causes a raised temperature, but does not cause pale stool, jaundice, or dark urine.
10008247
c
Appendicitis
QuestionChoice
Incorrect - Peptic ulcers are lesions in the mucosa of the digestive tract. They occur more frequently in the duodenum than in the stomach. Peptic ulcers are associated with epigastric pain and patients will often report heartburn. A peptic ulcer would not cause the patient to have pain worse on inspiration, pale stool, jaundice, or dark urine.
10008249
e
Peptic Ulcer
QuestionChoice
Correct - This is obstructive jaundice. Bile flow is obstructed by the gallstones, causing conjugated bilirubin to enter the blood. Conjugated bilirubin, being water soluble, is excreted in the urine, which makes the urine dark. By contrast, less conjugated bilirubin enters the bowel, leading to pale faeces. The pain in the right subcostal margin is called Murphy's sign and occurs due to irritation of the gallbladder.
10008245
a
Gallstones
QuestionChoice
Incorrect - Abdominal aortic aneurysms do cause abdominal pain. However, they would not cause pale stool, jaundice, or dark urine.
10008246
b
Abdominal Aortic Aneurysm
QuestionChoice
Incorrect - Acute pancreatitis can be caused by gallstones (remember the acronym I GET SMASHED) but this does not correlate with the entire clinical picture. Pain caused by pancreatitis is typically epigastric in nature and can radiate through to the back. Pale stool, dark urine, and jaundice also indicate the presence of biliary obstruction.
10008248
d
Acute Pancreatitis
Concept
Chapter
2693
4654
Approach to Central Abdominal Pain
Topic
135
General surgery
14196
A 45-year-old woman presents to the accident and emergency department complaining of severe colicky abdominal pain in the right upper quadrant. It came on shortly after eating dinner the previous night. The pain does not radiate through to her back, but she does describe pain in her right shoulder when breathing deeply. She comments that she has noticed her urine has been darker and her stools pale for the past few days.

On examination, she is visibly jaundiced and appears unwell. There is localised tenderness around the right subcostal margin, that is exacerbated by breathing in. Her temperature is 37.9. Her BMI is 35.

Which of the following is the most likely underlying diagnosis?
a