Your 44-year-old female patient complains of right upper quadrant ...

[madam-professor]

Your 44-year-old female patient complains of right upper quadrant pain. Her skin and sclera are yellow, and she has hyperbilirubinemia and elevated liver enzymes. The clinician should suspect:
 
  A. Acute pancreatitis
  B. Biliary duct obstruction
  C. Acute hepatitis
  D. Atypical appendicitis

Question 2

On abdominal examination as the clinician presses on the right upper quadrant to assess liver size, jugular vein distension becomes obvious. Hepatojugular reflux is indicative of:
 
  A. Acute hepatitis
  B. Right ventricular failure
  C. Cholecystitis
  D. Left ventricular failure

[succesfull]

Answer to Question 1

ANS: B
In cholecystitis, acute colicky pain is localized in the RUQ and is often accompanied by nausea and vomiting. Murphy's sign is frequently present. Fever is low grade, and the increase in neutrophilic leukocytes in the blood is slight. Acute cholecystitis improves in 2 to 3 days and resolves within a week; however, recurrences are common. If acute cholecystitis is accompanied by jaundice and cholestasis (arrest of bile excretion), suspect common duct obstruction.

Answer to Question 2

ANS: B
Hepatojugular reflux is elicited by applying firm, sustained hand pressure to the abdomen in the midepigastric region while the patient breathes regularly. Observe the neck for elevation of the jugular venous pressure (JVP) with pressure of the hand and a sudden drop of the JVP when the hand pressure is released. Hepatojugular reflux is exaggerated in right heart failure.

[madam-professor]

Excellent

[shailee]

Thanks for the timely response, appreciate it