Roberta I: In Pain

Gastrointestinal System

{"ops":[{"insert":"Clinical Reasoning"},{"insert":"\n","attributes":{"header":1}},{"insert":"Decision 1: the probable diagnosis"},{"insert":"\n","attributes":{"header":2}},{"insert":"Roberta has presented with continuous right upper abdominal pain, with radiation to the right upper back. She is also nauseous. Examination reveals tenderness and guarding in the same region, and a positive Murphy\u0027s sign. When considered together, these findings are most suggestive of acute cholecystitis. \n\nNote that both acute pancreatitis and peptic ulcer disease cannot be excluded via the above findings; however, in this context, they are clinically less likely than acute cholecystitis.\nDecision 2: the imaging modality to order"},{"insert":"\n","attributes":{"header":2}},{"insert":"Ultrasound is generally the preferred initial imaging modality in patients with suspected acute cholecystitis, both because it has reasonable sensitivity for the detection of acute cholecystitis and gallstones; and because it is cheap, rapid to perform, and freely available in many settings.\n\nStudents have shown computed tomography (CT) to have a higher sensitivity for the diagnosis of acute cholecystitis vis-a-vis ultrasound. However, CT is inferior for the detection of gallstones\u2014a point of practical importance, since the further management depends on whether the patient has calculous or acalculous cholecystitis. CT is also more expensive while also exposing the patient to ionizing radiation. Because of all these reasons, CT is probably"}]}

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