MEDICAL

AN OVERWEIGHT 40-YEAR-OLD WOMAN PRESENTS WITH SEVERAL WEEKS’ HISTORY OF TIREDNESS, INCREASING JAUNDICE AND COLICKY RIGHT UPPER QUADRANT PAIN. ON THE DAY OF ADMISSION SHE HAS DEVELOPED ATTACKS OF PROFOUND SHIVERING WITH SHAKING, HIGH TEMPERATURES AND MALAISE. THE MOST LIKELY DIAGNOSIS IS WHICH OF THE FOLLOWING

  • A. Viral hepatitis
  • B. Alcoholic hepatitis
  • C. Biliary obstruction due to gallstones with superadded biliary sepsis ✓
  • D. Malaria
  • E. Cirrhosis and urinary tract infection

 

In the case presented, the symptoms of tiredness, increasing jaundice, colicky right upper quadrant pain, attacks of profound shivering with shaking, high temperatures, and malaise suggest a more serious condition involving biliary obstruction with possible superadded biliary sepsis. The combination of jaundice, right upper quadrant pain, and systemic symptoms like fever and shivering points towards a potential blockage in the bile ducts due to gallstones. The presence of chills, fever, and malaise could indicate an infectious process on top of the biliary obstruction.

In other words, this diagnosis is suggested by the combination of symptoms including jaundice, right upper quadrant pain, fever, and shivering which are indicative of a possible biliary obstruction due to gallstones. The presence of jaundice and colicky right upper quadrant pain suggests an issue with the biliary system, while the fever and shivering could indicate an infection such as biliary sepsis.

Viral hepatitis (Option A) typically presents with symptoms such as fatigue, jaundice, and malaise but may not manifest with colicky right upper quadrant pain or profound shivering. Alcoholic hepatitis (Option B) can cause jaundice and right upper quadrant pain but is less likely to present with attacks of profound shivering and shaking. Malaria (Option D) usually presents with symptoms like fever, chills, sweats, fatigue, body aches but does not typically involve jaundice or right upper quadrant pain. Cirrhosis and urinary tract infection (Option E) may have overlapping symptoms like tiredness but are less likely to present with colicky right upper quadrant pain and profound shivering.

Therefore, based on the constellation of symptoms described in the scenario provided, C. Biliary obstruction due to gallstones with superadded biliary sepsis appears to be the most likely diagnosis.

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