Mrs. Neal, 54, presents at the ER complaining of abdominal
pain. She is overweight, pale, and jaundiced. Her BP is
145/98 and her HR is 102 beats/minute. She describes the
pain as severe and steady accompanied by nausea and
vomiting. She sits leaning forward and indicates that the
pain is in her epigastric region radiating up to her right
shoulder. Mrs. Neal's medical history shows that she has
had several episodes of biliary colic. She says her pain is
similar but lasts longer. Her last meal was a cheese pizza the
previous night, and her pain began 3-4 hours after eating.
The doctor orders blood work and an ultrasonography. The
ultrasonography reveals dilation of her bile and pancreatic
ducts and gallstones lodged in her hepatopancreatic
ampulla. Blood tests come back positive for pancreatic
amylase and pancreatic lipase.
A. Based on the information, what would be your medical
diagnosis? Support your diagnosis with evidence from the
scenario.
B. What treatment would you advise Mrs. Neal?
