Question

Ms. Burton, 48, presents at the clinic complaining of abdominal pain. She is a middle-aged woman, overweight, pale and sweating, with jaundice (yellowish slcin and sclerae). Her heart rate is I 02 beats/ min and BP is 145/98 mm Hg. She describes the pain as "severe" and "steady" over the past night, accompanied by nausea and vomiting. She siL~ leaning forward and indicates that the pain is in the epigastric region radiating up to the tip of the right shoulder. Ms. Burton's medical history shows that she has had several episodes of biliary colic (pain caused by gallstones going through the bile duct). She says her current pain is "sort of like that, but it's lasted longer." She says her last meal was a seven-cheese pizza the previous night, and that the pain began 3-4 hours after eating. She denies drinking or smoking.

1.When Ms. Burton previously had gallstones, they passed through her biliary ducts into her duodenum and the pain resolved. What structures (in order) did the stones pass through?

2. Which of the following correctly interprets these results?

a. The location of the gallstone is good news because it shows that the stone has almost passed into the duodenum.

b. The location of the gallstone is a problem because it blocks bile from entering the duodenum and forces bi le up into the pancreas.

c. The presence of pancreatic enzymes in the blood is good news because it indicates that the pancreas is still functioning.

d. The dilation of the ducts is good news because that will make it easier for gallstones to pass.

Answer 1

1) Gall stone pass through these structure - From Gall Bladder to Cystic duct --> Bile duct & its spincter-->Major duodenal papila --> duodenum ---> jejunm --> Ileum -->Cecum --> ascending colon -->transverse colon --> decending colon --> sigmoid colon --> rectum & anal canal.

2) Ans -The locaton of gallstone is a problem because it blocks bile from entering the duodenum and force bile up into pancreaes.

Gall stone gets impacted at major duodenal papilla. Hence it gets dilated and causes pain and other symptoms.