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Question 286 · LEK · Surgery of the bile ducts and gallbladder

A 53-year-old man presented to the emergency department due to post-prandial epigastric pain and pruritus. The patient also reports dark-coloured urine. Examination reveals yellowish colouration of the sclera and skin. Rectal examination found a discoloured stool in the rectal ampulla. Laboratory investigations: HGB 12.5 g/dL, HCT 36%, CRP 5 mg/L, bilirubin 80 μmol/L (4.68 mg/dL). Ultrasonography shows a common bile tract 11 mm in diameter with stone present and a thin-walled gallbladder without deposits and without wall thickening. Select the correct diagnosis and management:

  1. A. acute cholecystitis - laparoscopic cholecystectomy with antibiotic therapy.
  2. B. cholangitis - medical management with antibiotic therapy.
  3. C. cholangitis - endoscopic retrograde cholangiopancreatography with antibiotic therapy.
  4. D. choledocholithiasis - patient qualification for endoscopic retrograde cholangiopancreatography. 97 z 117 29.06.2026, 14:15 Centrum Egzaminów Medycznych https://test.cem.edu.pl/pytcem/wyswietl_baza_pdf.php
  5. E. provided information is insufficient to establish a diagnosis, and all options are equally likely.
Hint

Note the normal temperature and CRP alongside obstructive jaundice and a stone in a dilated common bile duct.

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