Discussion Board
She is calm and appropriate, non-toxic appearing.
Her abdominal exam is obese/soft/mildly tender. She has mild guarding in the right upper quadrant and her inspiration halts with deep palpation in this area. She has no rebound tenderness. The remainder of her examination is unremarkable.
What are your differential diagnoses? What would be your next step in terms of evaluation?
What is the difference between biliary colic/gall stones/cholangitis? How do their treatments differ?
You recommend a change in diet and she states that her abdominal pain and distention have improved after meals. She is also working on losing weight. She appreciates the advice you have given. However, a few months later she developed severe acute abdominal pain.
You see her in the emergency room and she has severe diffuse abdominal pain which radiates into her back and is associated with nausea/vomiting. She is afebrile but appears ill. Her exam is now remarkable for abdominal distention, guarding, and rebound tenderness diffusely.
What is your concern now in terms of diagnosis? What initial testing would you order and what would be your treatment? Do any scoring/prognostic systems exist to determine morbidity/mortality from this diagnosis?
Finally, is it a good idea to take her gallbladder out acutely?
Discussion 1B
Male GU Case Discussion
You have an elder gentleman coming in for his annual follow-up. He is 78 years old and is very healthy and active for his age. As part of your screening, you perform a digital rectal examination and check a PSA level. His exam is notable for an enlarged prostate but no palpable lumps or masses. His PSA is elevated but stable from last year at 6.0ng/ml.
What is PSA and why does the normal range increase with age?
When is it a useful test for helping to differentiate BPH versus prostate CA? When would a referral for a biopsy be warranted?
Do most patients diagnosed with prostate cancer eventually die from it or something else?
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